f 


GIFT  OF 


WILMER    COFFMAN 


University  of  California  •  Berkeley 


A 

TREATISE 

ON       THE 

MANAGEMENT    OF    PREGNANT 

AND 

LYING    IN    WOMEN, 

AND  THE  MEANS  of  CURING,  BUT  MORE  ESPECIALLY  OF 

PREVENTING  THE  PRINCIPAL  DISORDERS 

TO    WHICH    THEY    ARE    LIABLE, 
TOGETHER      WITH      SOME 

NEW     DIRECTIONS 

CONCERNING     THE 

DELIVERY  OF  THE  CHILD  AND  PLACENTA 

IN     NATURAL     BIRTHS, 

ILLUSTRATED    WITH    CASES. 


By   CHARLES   WHITE,  ESQ.  F.  R.  S. 

Man  Midwife  to  the  Lying  in  Hofpital,  in  Manchefter,  in  England,  &c.  &c» 


PRINTED    at   WORCESTER,    MASSACHUSETTS, 
BY     ISAIAH     THOMAS. 

Sold  at  his  Bookftore  in  WORCESTER.  Sold  alfo  by  faid  THOMAS,  and  ANDREWS, 
Fauft's  Statue,  ^cwbury  Street,  BOSTON  ;  and  by  faid  THOMAS, 
Newhampfliire. 

MDCCXCIJI. 


f  r 


n/u 


, 


' 


. 

- 

I'     'A.-i-i'  •  '' 


•-';•' 

• 


P     R  F     ACE. 


IHE  intention  of  the  following 
Treatife  is  to  propofe  proper  means  for  pre- 
venting a  numerous  and  fatal  train  of  evils,  in- 
cident to  the  moft  amiable  part  of  the  creation  j 
to  combat  a  fet  of  pernicious  maxims  and  opin- 
ions, built  upon  ignorance,  and  fupported  by 
prejudice  and  obftinacy  ;  and  to  vindicate  Na- 
ture herfelf  from  a  charge  of  negled:  or  infuffi- 
ciency  in  her  moft  important  work.  I  hayeno 
curious  fingularities  in  theory  to  propofe,  nor 
any  fpecific  remedy  to  extol  j  the  only  merit  I 
claim,  is  merely  that  of  having  attended  to,  and 
followed  Nature  in  her  operations  more  clofely, 
and  with  a  more  religious  obfervance  than  hith- 
erto perhaps  has  been  done. 

At  a  time  when  reafoning  from  real  fads  and 
Accurate  obfervation  has  taken  place  of  idle  theory 

in 


-viii  PREFACE. 

in  almoft  every  other  fcience,  and  has  with  par- 
ticular advantage  been  applied  to  many  branch- 
es of  medicine,  no  apology  feems  neceflary  for 
trying  the  fame  method  of  reafoning,  on  this 
important  fubjedt,  which  has  hitherto  been  too 
much  governed  by  arbitrary  cuftom,  and  igno- 
rant prejudice. 

On  reflecting  upon  the  caufe  why  lefs  prog- 
refs  has  been  made  in  the  prevention  and  cure 
of  the  diforders  which  fo  fatally  attack  lying  in 
women,  than  in  many  others,  it  feems  moft  ob- 
vious to  impute  it  to  preconceived  notions  rel- 
ative to  the  puerperal  ftate,  not  founded  upon 
fa6h  For  while  a  more  rational  general  doc- 
trine of  fevers,  and  the  ufe  of  cool  air  and  regi- 
men in  their  cure  (ever 7ince~tHe"time~oF5yden- 
ham,  and  efpecially  of  late)  has  been  advanced 
and  fupported  by  the  fpirited  endeavours  of 
many  able  men,*  prejudices  of  ancient  date 
have  too  much  prevented  the  application  of 
their  principles  to  the  febrile  diforders  of  pu- 
erperal women,  which  were  conceived  to  be  of 
that  peculiar  nature  of  which  every  thing  be- 
longing to  this  ftate  partook.  Every  improve- 
ment in  practice  muft  therefore  take  its  rife 
from  the  eftablifhment  of  more  juft  ideas  con- 
cerning 

*  Friend,  Glafs,  Huxham,  Pringle,  Lee,  Perkins,  Huck,  Dimfdale, 
Heberdenj  Erockklby,  Rufton,  Watfbn,  Baker,  Kirkland,  and  many 
others. 


PREFACE.  hi 

cerning  the  ftate  itftif,  and  the  caufes  of  the 
diforders  accompanying  it ;  and  by  a  proper 
attention  to  thefe,  I  an.  experimentally  con- 
vinced that  not  only  the  method  of  cure  may  be 
much  advanced,  but  what  i±  ftill  more  impor- 
tant, that  thefe  mifchiefs,  fo  dtftrefling  and  dan- 
gerous, may  be  entirely  prevented. 

This  then  will  be  my  chief  aim  in  the  fol- 
lowing Treatife ;  and  if  in  purfuing  it,  I  may 
feem  to  pay  more  attention  to  fome  minute  cir- 
cumftances,  than  they  really  deferve,  let  it  be 
remembered  that  the  flighted  remark  drawn 
from  real  obfervation,  is  of  more  utility,  and 
gives  greater  fatisfadlion  to  a  judicious  inquir- 
er, than  the  moft  extenfive  theory  of  caufes 
drawn  from  hypothecs  alone. 

We  are  too  apt  to  negled:  what  is  fimple  and 
;evident,  for  the  fake  of  thofe  creations  of  the 
mind  which  may  be  produced  at  pleafure;  but 
a  fingle  argument  drawn  from  certain  fad:,  is  a 
furer  ground  to  reft  upon  than  an  entire  fyftem 
of  fpeculative  invention.  So  important  a  law 
of  Nature  as  the  circulation  of  the  blood,  was 
deduced  from  a  few  obvious  and  eafy  experi- 
ments, after  the  acute.fl  fpeculation  of  philofo- 
phers  had  failed  in  the  difcovery. 

Were 


x  PREFACE, 

Were  I,  indeed,  difpofecjto  reafon  in  favour  of 
the  doftrines  I  have  attempted  to  lay  down,  up- 
on any  other  ground  thaft  mere  obfervation,  vari- 
ous arguments,  botfy«  priori  and  from  analogy 
would  not  be  wan^g.  I  might  fay  it  is  incon- 
ceivable that  Nati/e  fhould  fufFer  her  moft  impor- 
tant procefs  to/oe  the  leaft  complete,  and  that 
flie  fhould  need  the  help  of  art  in  an  operation  al- 
moft  prior  to  art  itfelf.  In  her  inferior  produc- 
tions we  find,  that,  in  fad:,  fhe  does  not  require 
it.  Th?  procefs  of  renewing  the  fpecies,  in 
the  vegetable  creation,  is  performed  entirely  by 
her  unerring  power  :  and  the  fruit  when  it  be- 
comes fully  ripened,  drops  off  fpontaneoully 
without  the  hand  of  art  to  feparate  it.  In  the 
whole  animal  race  this  procefs  is  equally  dif- 
tant  from  difeafe.*  e  Why  then  ftiould  the 
human  fpecies  alone,  her  nobleft  production, 
undergo  her  unkindnefs  or  negleft  in  fo  ma- 
terial an  objedt  ?  Though  pain  in  bringing 
forth  their  offspring  might  be  an  unavoidable 
circumflance  in  the  formation  of  mankind,  .it 
is  however  overbalanced  by  many  advantages  ; 
but  that  this  moil  neceffiiry  operation  mould  of 
itfelf  be  a  difeafe,  and  fhould  often  be  the  fource 
of  many  dangerous  and  even  fatal  maladies, 
appears  contradictory  to  the  general  plan  of  Na- 
ture 

*  The  author  here  does  not  mean  to  infmuate,  that  either  the  brute 
or  the  human  fpecies  are  at  all  times  exempt  from  preternatural 
births. 


PREFACE.  xt 

fure  in  the  fupporUnd  prefervation  of  her  crea- 
tures.* But  however  this  drain  of  reafoning 
may  pleafe  a  philofopVic  mind,  or  may  have 
turned  my  thoughts  to  a  peculiar .  way  of  con- 
fidering  the  fubject,  I  flioUd  never  have  ven- 
tured to  build  practical  rules  apon  fuch  a  foun- 
dation. I  have  offered  nothing  but  what  has 
been  the  refult  of  a  long,  extenfive,  and  I  may 
fay,  very  fuccefsful  experience  among  all  ranks 
of  women.  How  bold  foever  I  muy  feem  in 
inculcating  fome  unufual  practical  dire&ions, 
the  actual  cafes  which  I  have  related,  and  which 
are  only  felected  from  a  great  number  of  fimi- 
lar  ones,  will,  I  hope,  be  my  ample  juflifica- 
tion.  It  was  the  experimental  knowledge  of 
thefe,  and  of  the  mifchiefs  attending  a  contrary 

treatment,    which    alone    influenced   me   to  ad- 

drefs  the  public  on  thefe  fubjedts ;    and  I  defire 
to  fubmit  to  a  like  experimental  trial,  what  is 

here 

*  Mr.  Deparcieux  at  Paris,  and  Mr.  Wargentin  in  Sweden,  have 
obferved,  that  not  only  women  live  longer  than  men,  but  that  married 
women  live  longer  than  fingle  women.  The  regifters  examined  by 
Mr.  Muret  confirm  this  ;  and  it  appears  particularly,  that  of  equal 
numbers  of  (ingle  and  married  women  between  15  and  25,  more  of 
the  former  died  than  of  the  latter  in  the  proportion  of  two  to  one. 
Thereafon  of  this  may  be,  as  Mr.  Muret  acknowledges,  that  the  wom- 
en who  marry  are  a  felefted  body,  confiding  of  the  more  healthy  and 
vigorous  part  of  the  fex.  But  this  probably  is  by  no  means  the  on- 
ly reafon  ;  for  it  may,  I  think,  be  expeaed,  that  in  this,  as  well  as 
in  all  other  inttanccs,  the  confequences  of<  following  Nature  muft  be 
favourable. 

Supplement  to  Price's  Obferv.  on 
Reverftonary  Payments,  p.  357. 


CE. 


Rk  ••$;$ 

*if  PJR  E  F  A 

here  offered  to  the  judgment  of  the  candid 
reader. 


I  cannot  conclude  w/&out  gratefully  acknowl- 
edging the  many  ykligations  I  am  under  to 
thofe  of  my  learnt  friends,  who  have  aflifted 
me  in  revifing/fid  correcting  thefe  fheets,  and 
to  my  medicaj^orrefpondents  who  have  favour- 
ed me  with/o  many  ufeful  articles  of  informa- 
tion. Tli/ reader  will  at  once  fee  of  what  im- 
portance^hefe  have  been  in  enabling  me  to  de- 
duce the  practical  inferences  which  I  have  at* 
tempted  to  eftablifti. 


P.  S.  lam  happy  in  the  opportunity  this  fourth 
edition  offers  me,  of  exprejjing  my  fatisfattion  for 
the  reception  this  work  has  <*/reWr  met  with,  and 
my  hopes  that  its  extenjive  circulation  may  have 
f>een  a  means  of  accomplijhing,  in  a  confide r able 
degree  the  purpofes  it  was  intended  to  anfwer. 
Eejldes  three  pery  large  imp  regions  which  have 
been  called  for  at  home,  a  tranjlation  into  French 
has  been  pubHJhed  at  Paris,  and  an  Englifh  edi-* 
tion  was  in  the  prefs  at  Philadelphia  when  the 
late  troubles  began  in  that  country* 


THE 


THE     CONTENTS.  xv 

Page 

Cafe    XI.  Retention  of  tie  Placenta  occa- 
Jioning  a  fatal  Miliary  fever  2 1 3 

Cafe  XII.  Retention  of  the  Placenta  cc- 
cajioning  fatal  F loadings  -  -215 

Cafe    XIII.      do.                -  -            216 

Cafe    XIV.      do.               -  ibid. 

Cafe    XV.        do.                -  -           217 

CONCLUSION               -  -               218 

POSTSCRIPT              -  222 

Appendix  to  the  fecond  Edit  ion  -            252 

Sedt.    I.    On  the  ufe  of  the  cold  or  temperate 

Eath  -  -         253 

II.     On  the  delivery  of  the   Shoulders 
of  the  Child  -  -  254 

f  III.  An  Obfervation  on  the  Manage- 
ment of  Children  at  the  time  of 
Birth  -  257 

IV.  On  the  Puerperal  Fever  audPo- 
fition  after  delivery  261 

ADDITIONAL    CASES, 

Cafe  XVI.  A  Wound  of  the  Omentum  at 
the  full  period  of  Gejlation,  which  brought 
on  labour  *  •*  2^7 

Cafe 


THE     CONTENTS. 


Cafe  XVII.  A  fatal  Puerperal  Fever  with 
a  Diffe&ion  238 

Cafe  XVIII.  A  fatal  Puerperal  Fever  oc- 
cajianed  by  the  Effluvia  arijlng  from  foul 
Urine  -  297 

C^fe  XIX.  A  total  Inverfion  of  the  Uterus, 
returned  by  a  new  mode  of  operation  299 

Cafe  XX.  A  fatal  Puerperal  Sever  with 
a  Diffeftion  -  304 

Cafe  XXI.  A  remarkable  Retention  of  the 
Placenta  -  -  -  3°^ 

Cafe  XXII.  A  fatal  Mortification  of  the  U- 
terus,  with  Diffettion  -  -  311 


CHAPTER 


CHAPTER      L 


OF  THE  CAUSES  AND  SYMPTOMS  OF  THE  PUERPE- 
RAL OR  CHILD  BED  FEVER.f 


OMEN,  during  the  time  of  ly- 
ing in,  are  fubjeft  to  this  fever, 
which  has  frequently  evident 
fymptoms  of  putrefcency,  and 
which,  if  not  properly  managed 
has  often  fatal  effects . 


That  child  bed  women  mould  be  fo  liable  to  fe- 
vers, efpecially  thofe  of  a  putrid  nature*,  is  not  to  be 

wondered 

t  This  diforder  in  the  northern  part  of  this  Ifland  is  called  the  weed  ;  and 
in  the  fouthern  parts  by  fome,  the  lochial  fever. 

"  Puerpera  ex  male  affefti  corporis  vitio  tanquam  aurae  peftilentiails 
^^i  putrida,  feu  potius  TRtligngt  ^uam  nimium  obnoxiz  reperi- 

i 


*8         PUERPERAL    FEVER. 

wondered  at,  if  we  corifidef  every  circumftance,  and 
every  inconvenience  they  lie  under,  owing  to  bad 
fafhions  and  cuftoms  ;  but  to  trace  them  up  to. their 
original  fource  we  mufl  look  back  as  far  as  the  ear- 
ly months  of  pregnancy.  At  this  period  the  tight- 
nefs  of  the  flays,  and  petticoat  bindings,  the  weight 
of  the  pockets,  and  of  the  petticoats,  prefs  the  womb, 
already  enlarged  by  the  foetus,  and  its  membranes, 
fo  ftrongly  againfl  the  lower  inteflines,  as  to  pre- 
vent the  defcent  and  exclufion  of  the  excrements. 
Thefe  being  retained,  the  thinner  parts  are  abforbed 
by  the  la&eals,  which  caufe,  or  at  lead  greatly  in- 
creafe,  that  obftinate  coftivenefs  of  which  moil  wom- 
en complain  during  the  whole  time  of  pregnancy, 
and  which  is  alfo  farther  increafed  by  a  fedentary, 
inactive  life,  and  improper  diet.  This  excrementi- 

tious 

untur  ;  hujufce  vero  morbi  labem  hand  omnes  ex  zquo  fufcipiunt  :  etenim 
pauperes  rufticx,  aliseque  duris  laboribus  affuetz,  nee  non  viragines,  &  me- 
jretricesj  quz  clandeftina  agunt  puerperia,  fine  magna  difficultate  pariunt,  & 
deinceps  brevi  a  leftp  excitatae,  ad  folita  redeunt  opera  ;  mulieres  autem  di- 
tiores,  tenellae,  &  pulchrae,  pleraeque  vitam  fedentiaram  degcntes,  quafi  ma- 
ledifli  divini  graviori  modo  participes  in  dolorc  pariuntt  indeque  mox  a  par- 
tu  difficiles  &  periculofos  fubeunt  cafus." 

Willis  de  Febribus  Puerperarum,  Febres 
putridce  Caput  xvi. 

Willis's  account  would  not  have  been  liable  to  any  material  objefticn,  if 
lie  kad  not  excepted  the  poor  in  general,  for  it  is  now  well  known  that 
they  arr  very  liable  to  this  fever,  both  in  the  holpitals,  and  in  their  own  houfes, 
cfpecially  if  they  are  fituatcd  in  the  middle  of  large  manufacturing  towns  and 
cities  ;  but  there  is  this  to  be  faid  in  favour  of  the  Doftor,  that  it  is  above  a 
century  fmce  he  wrote  this  Treatife  on  the  Puerperal  fever,  at  a  time  when 
there  was  no  hofpital  for  lying  in  women  in  the  Britifh  dominions,  our  rr_an- 
ufaftories  were  then  in  their  infancy,  and  the  diet  and  mode  of  living  amongJJ 
the  poor  people,  were  totally  different  from  what  they  are  at  this  time* 


PUERPERAL    FEVER.        19 

tious  matter  being  abforbed  into  the  circulation, 
undoubtedly  occafions  a  great  inclination  to  putrid- 
ity ;  lofs  of  appetite  foon  follows,  and  the  ftotnach 
and  duodenum  being  no  longer  diflended  with  ali- 
ments, large  quantities  of  bile  are  collected  in  the 
gall  bladder,  the  cyftic  and  hepatic  duels,  and,  by 
lodging  there,  foon  acquire  a  putrid  or  putrefcent 
acrimony. 

When  the  woman  is  in  labour,  me  is  often  at* 
tended  by  a  number  of  her  friends  in  a  fmall  room, 
with  a  large  fire,  which,  together  with  her  own 
pains,  throw  her  into  profufe  fweats  ;  by  the  heat  J 
of  the  chamber,  and  the  breath  of  fo  many  people, 
the  whole  air  is  rendered  foul,  and  unfit  for  refpira- 
tion  *  ;  this  is  the  cafe  in  all  confined  places,  hof- 
pitals,  jails,  and  fmall  houfes,  inhabited  by  many 

families, 

*  Dr.  Thomas  Cooper,  fpeaking  of  the  lochial  fever,  fays,  "  This  fever  is 
moft  common,  and  alfo  more  fatal  in  the  hotter  months." 

Compend.  of  Midwifery,  p.  220.  Lond.  1766. 

*  It  has  been  found  by  Dr.  Stephen  Hales  (Statical  Effays,  Vol.  2,  p.  324) 
that  a  pcrfon  in  health  deftroys  two  gallons  of  air  in  two  minutes  and  a  half, 
fo  as  to  render  it  unfit  for  refpiration. 

Dr.  Percival  informs  me  that  a  correfpondcnt  of  his,  (a  gentleman  diftin- 
guifned  for  his  knowledge  of  Natural  and  Experimental  Philofophy)  has  lately 
difcovered  "  That  air  which  animals  have  breathed  is  in  all  refpe&s  the  fame 
•with  air  in  which  animals  have  putrified.  The  original  quantity  is  equally  di~ 
minifhed  in  both  cafes  ;  which  is  found  to  be  owing,  in  part  at  lead,  to  the 
precipitation  of  the  fixed  air  it  contained  ;  and  they  are  rxe ftorcd  by  the  fame 
procefs.  One  ufe  of  the  lungs  therefore  muft  be  to  carry  off  a  putrid  effluvi- 
um, without  which  a  living  body  might  perhaps  putrify.  as  well  as  a  dead  one." 

B    2 


20  PUERPERAL    FEVER. 

Families,  where  putrid  fevers  are  apt  to  be  generat- 
ed, and  proportionally  the  more*  fo  where  there  is 
the  greateft  want  of  free  air. 

If  the  woman's  pains  be  not  ftrong  enough,  her 
friends  are  generally  pouring  into  her  large  quan- 
tities of  ftrong  liquors,  mixed  with  warm  water,  and 
if  her  pains  be  Very  ftrong,  the  fame  kind  of  reme- 
dy is  made  ufe  of  to  fupport  her.     As  foon  as  (he 
is  delivered,  if  me  be  a  perfon  in  affluent  circum- 
ftances,  me  is  covered  up  clofe  in  bed  with  addi- 
tional clothes,  the  curtains  are  drawn  round  the 
bed,  and  pinned  together,  every  crevice  in  the  win- 
clows  and  door  is  flopped  clofe,  not  excepting  even 
the  key  hole,  the  windows  are  guarded  not  only 
with  mutters,  and  cu.rtain«^  tuit  euen  with  blankets,, 
the  more  effectually  to  exclude  the  freih  air,  and 
the  good  woman  is  not  fuffered  to  put  her  arm,  or 
even  her  nofe  out  of  bed,  for  fear  of  catching  cold. 
She  is  conftantjy  fupplied  out  of  the  fpout  of  a  tea- 
pot with  large  quantities  of  warm  liquors,  to  keep 
up  perfpiration  and  fweat,  and  her  whole  diet  con- 
fifts  of  them.     She  is  confined  to  a  horizontal  pof- 
ture  for  many  days  together,  whereby  both  the  ftools 
and  lochia  are  prevented  from  having  a  free  exit. 
This  happens  not  only  from  the  pofture  of  the  pa- 
tient, but  alfo  from  the  great  relaxation  brought  on 
by  warm  liquors  and  the  heat  of  the  bed  and  room, 
which  prevent  the  over  diitended  abdominal  muf* 

cles 


PUERPERAL    FEVER,        fti 

cles  from  fpeedily  recovering  their  tone,  whereby 
they  are  rendered  unable  to  expel  the  contents  of 
the  abdomen,  which  lodging  in  the  interlines  many 
days,  become  acrid  and  quite  putrid. 

The  lochia  ftagnating  in  the  womb,  and  in  the 
folds  of  the  vagina,  foon  grow  acrid,  for  it  is  well 
known  that  themildeft  humours  in  the  human  bo,dy, 
if  fuffered  to  Magnate,  become  fo,  as  foon  as  the  air 
has  accefs  to  them.  Thefe  are  in  part  abforbed  by 
the  lymphatics  in  the  womb  and  vagina,  and  the 
effluvia  from  them  help  to  make  the  air  in  the  bed, 
and  in  the  room,  more  putrid ;  this  air  in  every 
act  of  infpiration  is  taken  into  the  lungs,  and  is 
there  again  received  into  the  circulation :  Add  to  this 
that  women  are  general!^  of  9.  lei  A,  feldom  of  a  rigid 
fibre,  owing  in  fomemeafure  to  their  periodical  evac- 
uations, to  their  fedentary,  inactive,  and  domeftic 
way  of  life,  and  likewife  to  their  mufcles  being  fur- 
rounded  with  a  much  larger  quantity  of  cellular 
membrane,  than  thofe  of  men ;  hence  alfo  they  ar- 
rive at  their  acme  fooner  than  men. 

Amongft  the  poor  people  who  live  in  cellars,  and 
upon  clay  ground  floors,  the  air  is  ftill  made  worfe 
by  the  dampnefs  and  clofenefs  of  their  houfes, 
and  the  want  of  clean  linen,  and  cleanlinefs  in 
general.  Thofe  who  live  in  garrets  are  alfo  in  no 
better  a  fituation,  for  the  putrid  miafmata  of  feveral 
B  3  families 


22         PUERPERAL   FEVER, 

families  inhabiting  the  lower  part  of  the  houfe, 
afcend  to  them,  already  fufFering  perhaps  from  the 
effluvia  of  a  whole  family  in  every  fmgle  room,  the 
putridity  of  which  is  farther  increafed,  by  the  heat 
of  the  fun  piercing  through  the  covering  of  the 
houfe ;  nor  is  it  to  be  wondered  at  that  they  are  ft  ill 
in  a  worfe  fituation  in  hofpitals*,  where  a  number 

are 

*  "  II  a  regnc  pendant  Phiver  de  i746une  maladie  epidemique  parmHes 
femmes  encouche :  M.  de  Juflieu  a  le  premier  obferve  cette maladie  ;elle  corn- 
menjoitpar  ledevoiemcnt,  ou  parunc  difpofition  audevoiement,qiricontinuoit 
pendant  la  couche  :  les  caux  qui  accompagnent  ordinaircment  la  naiflanee  de 
1'enfant,  fortoient  pendant  le  travail  de  Paccouchement ;  raaisapres  ce  temps, 
la  matrice  devenoit  feche,  dure  &  doloreufe,  elle  etoit  enflee,  &  les 
vffidanges  n'avoient  pas  leur  cours  ordinaire. 

Enfuite,  ces  femmes  etoient  prifes  de  douleurs  dans  les  entrailles,  fur-tout 
dans  les  parties  qu'occupent  lesligamens  larges  de  la  matrice;  le  ventre  etoit 
tendu,  &.  tous  ces  accidens  etoient  accompagncs  atmc  «lauleur  ds  tete,  & 
ouelquefois  de  la  toux. 

Le  troifieme  &  le  quatrieme  jour  apres  Pacouchcment,  les  mammelfes  fe 
fletvifToient,  au  lieu  qu'elles  durciffent  &  fe  gonflent  naturellement  dans  ce 
temps  par  le  lait  qui  s'y  filtre  alors  en  plus  grande  quantite  :  enfin  ces  femmes 
inoaroient  entre  le  cinquieme  &  le  feptieme  jour  de  Pacouchement. 

Cette  maladie  n'a  attaque  que  les  pauvres  femmes,  &  elle  n'a  pas  ete  aufli 
violente,  ni  aufli  commune  parmi  les  pauvresfemmesqui  ont  accouche  chez  elles, 
que  parmi  celles  qui  ont  ete  accouchees  a  1'Hotel  Dieu  ;  on  a  remarque  que 
dans  le  moi  de  Fevrier,  de  vingt  des  ces  femmes  malades  en  couche  a  1'Hotal 
Dieu,  a  peine  en  echappoit-il  une  :  cette  maladie  n'a  pas  ete  fi  meurtriere 
dans  le  refte  de  Phiver.  Meffrs.  Col  de  Villars  &  Fontaine,  Medecins  de  cet 
Hopital,  nous  ont  rapporte  qu'a  Pouverture  des  cadavres  de  ces  femmes,  ils 
avoient  vu  du  lait  caille  &  attache  a  la  furface,  externe  des  inteftins,  &  qu'il  y 
avoit  une  ferofite  laiteufe  epanchee  dans  le  bas  ventre  ;  ils  ont  meme  trouve 
aufli  de  cette  ferofite  dans  la  poitrine  de  quelquis  unes ;  &  lorfqu'on  en 
coupoit  les  poumonsj  ils  degorgeoicnt  une  Jymphe  laiteufe  &  pourrie. 

l.'cftom»c, 


PUERPERAL    FEVER.         33 

are  crowded,  not  only  in  one  houfe,  but  in  one 
ward?  where  the  difeafe  is  conveyed  from  one 
to  another  by  the  putrid  miafmata  lodging  in 
the  curtains,  bed  clothes,  and  furniture,  and  by 
the  necefTary  houfes,  which  are  either  contiguous 
to,  or  fo  near  the  hofpital  as  to  occafion  a  moft  dif- 
agreeable  fmell,  and  muft  of  courfe  convey  that  in- 
fection^ which  cannot  be  more  effectually  com- 
municated, than  by  the  excrements. 

This  defcription  may  perhaps  feem  overcharged 
for  a  picture  of  that  improved  practice  which  is  in- 
troduced by  modern  profeffors  of  the  art;  but  up- 
on a  clofe  examination,  I  believe  it  will  appear  that 
many  of  the  moft  important  errors  do  in  reality 
prevail,  and  this  I  impute  in  great  meafure  to  the 
large  mare  which  nurfes  have  in  directing  the  man- 
agement of  lying  in  women,  to  whofe  interference 

practitioners 

L'eftoinac,  les  inteftins  &  la  matriccbien  examinees,  paroifibient  avoir  etc 
enflamm.es,  &  il  eft  forti,  fuivant  le  rapport  de  ce.s  deux  Mcdecins,  de*  gru- 
meaux  de  fang  a  1'ouverture  des  caneaux  dc  la  matrice. 

Dans  pleuficurs  de  ccs  femnaes,  les  ovaires  paroiffoient  avoir  etc  en  fup- 
Puration.  '* 

Hift.  de  1'Acad.  Royalc  des  Sciences 
1'an  1746,  410.  p.  160. 

*'  I  am  well  informed  that  this  fever  and  obftru&ion  occur  more  frequent- 
ly  in  the  lying  in  hofpitals,  than  in  private  practice.  What  can  this  arife 
from  but  from  the  different  ftates  of  air  ?  This  in  my  opinion  is  the  caufe  ; 
for  though  very  great  care  is  taken  in  thofe  hofpitals,  yet  as  the  apartments 
and  furniture  will  imbibe  fome  of  the  morbid  effluvia,  arifing  from  the  pa- 
tients, >he  air  muft  always  be  more  or  lefs  tainted." 

Johnfon'«  Midwifery,  p 
B4 


»4  PUERPERAL  FEVER. 

pra&itioners  muft  in  fome  meafure  fubmit,  though 
contrary  to  their  better  judgment. 

Women  have  frequently  many,  and  fometimes 
all  of  thefe  difficulties  to  ftruggle  with,  even  after 
the  moil  eafy  deliveries  ;  but  if  there  have  been 
fuch  violence  ufed,  either  by  inflruments  or  by  the 
kand,  in  the  extraction  of  the  child  or  the  placenta, 
as  to  bring  on  an  inflammation  of  the  womb,  thefe 
difficulties  will  flill  be  farther  increafed.  The  pa- 
tient may  likewifebeput  upon  her  labour  too  foon, 
by  endeavouring  to  dilate  the  os  internum,  or  be 
too  frequently  teazed  with  unfuccefsful  attempts  to 
deliver  her,  or  after  the  head  is  born,  the  body  of 
the  child  may  be  delivered  too  fuddenly,  and  too 
forcibly,  without  waiting  for  another  pain,  or  giv- 
ing the  moulders  time  to  accommodate  tkemf elves 
to  the  different  dimenfions  of  the  pelvis,  the  bad  ef- 
fect of  which  I  will  explain  more  at  large  hereafter. 

In  a  few  days  after  delivery  the  patient  is  perhaps 
feized  with  a  fhivering  fit,  and  the  nurfe  is  furprif- 
ed,  as  me  protefts  fhe  has  not  had  the  leaft  waft 
of  cold ;  more  clothes  are  heaped  upon  her :  fpiri- 
tuous  liquors,  and  hot  fpices,  are  given  her,  to  throw 
off  the  cold  fit,  which  mofl  certainly  increafe  the 
fucceeding  hot  one.  A  warm  room,  plenty  of 
clothes,  and  warm  drinks  are  continued  to  throw 
her  into  a  fweat,  but  have  frequently  a  contrary  ef* 
feel;,  by  increafing  and  prolonging  the  burning  fit, 


PUERPERAL   FEVER.  35 

which  at  laft  terminates  in  a  moft  profufe  fweat, 
continuing  many  nights  and  days  without  giving 
relief.  ' 

The  cold  fit  fometimes,  like  the  paroxyfm  of  an 
ague,  returns,  but  at  uncertain  periods,  and  at  laft 
ends  in  a  continued  fever ;  At  other  times  no  cold 
fit  precedes  the  difeafe  :  It  creeps  on  gradually,  and 
firft  Ihews  itfelf  by  putrid  fweats,  attended  with  a 
naufea,  or  by  vomitings  of  porraceous  matter,  and 
a  loofenefs.  What  the  patient  vomits  is  generally 
mixed  with  large  quantities  of  bile  of  a  dark  colour. 
The  ftools  are  fometimes  very  copious  and  frequent, 
and  fo  exceedingly  putrid  as  to  be  offenfive  all  over 
the  houfe,  and  to  convey  infe&ion  to  the  whole 
,  family  :  At  other  times  the  patient  is  racked  with  a 
conftant  tenefmus,  and  with  frequent  motions  to 
make  water,  accompanied  with  fwelling,  pain,  and 
forenefs  in  the  belly,  and  with  pains  in  the  head, 
back,  breafts  fides,  hips,  and  iliac  region,  with  a 
cough  and  difficulty  of  breathing;  there  is  com- 
monly a  wildnefs  in  the  countenance,  and  the  head 
feems  hurried,  and  in  fome  cafes  the  face  is  flulh- 
ed ;  the  urine  is  voided  often,  with  pain,  and  in 
fmall  quantities,  and  is  remarkably  turbid. 

The  tongue  at  nrfl  is  white  and  moift,  and  foon 
after  is  covered  with  a  white  fur,  or  elfe  it  is  dry, 
hard,  and  brown,  and  afterwards  covered  with  a 
brownifh  fur  ;  a  brown  or  blackifh  fordes,  the  con- 

fequence 


*6  PUERPERAL   FEVER. 

fcquence  of  putrid  exhalations,  adheres  to  the  edges 
of  the  teeth.      The  patient  ufually  naufeates  all 
kinds  of  food  and  drink,  except  what  is  cold  and 
acidulated.     The  pulfe  at  the  beginning  of  the  dif- 
order  is  fometimes  very  little  -altered,  only  fome- 
thing  fuller  and  quicker,  but  as  the  diforder  advan- 
ces, it  never  fails  to  grow  quick,  fmall,  and  creep- 
ing, and  the  patient  complains  of  great  anxiety,  and 
oppreflion  about  the  praecordia,  attended  with  figh- 
ings,  lownefs  of  fpirits,  laffitude  and  great  debility. 
The  quantity  of  the  lochia  is  frequently  not  at  all 
diminifhed,  at  other  times  it  is  very  much  leffened: 
What  flow  are  fometimes  very  foetid,  and  in  fome 
cafes  this  difcharge  is  totally  fupprefled. 

The  breafls  in  fome  grow  flaccid,  the  milk  abates 
in  quantity,  and  if  the  diforder  be  not  foon  remov- 
ed, is  entirely  loft ;  but  this  is  not  always  the  cafe, 
i 

If  the  hot  regimen  be  continued,  with  vinous  fpi- 
cy  caudles,  hot  alexipharmic  medicines,  volatile  al- 
caleous falts  and  fpirits,  opiates,  and  a  clofe  room  fo 
as  to  keep  the  patient  in  a  perpetual  fweat,  vibices* 
or  petechiae  appear,  or  eruptions  either  of  the  white 

or 

*  Cooper  fpeaking  of  this  fever  about  the  fourth  day,  fays,  "  Now  if  nat 
before,  fome  violent  pains  come  on,  in  the  -arms,  and  thighs,  fuccecded  by  a 
difcolouration  of  the  fkin,  occafioned  by  the  blood  corroding  and  ftagnating 
in  the  veflels." 

Compend.  of  Midwifery,  p.  218. 


PUERPERAL   FEVER.  2? 

or  red  kind,  or  both,  firft  upon  the  neck  and  breafts, 
afterwards  extending  themfelves  all  over  the  body, 
one  crop  fucceeding  another  till  the  patient  is  worn 
out  ;  but  they  give  no  relief,  are  not  in  any  way 
critical,  nor  is  there  indeed  any  regular  crifis  in  this 
diforder,  except  the  loofenefs. 

The  patient  is  generally  eafier  after  every  flool, 
and  they  feem  to  give  relief.  The  ftools  at  laft  are 
difcharged  together  with  the  urine,  involuntarily ; 
colliquative  fweats,  hiccupings,  convulfions,  &c. 
come  on ;  and  death,  whickhappens  fometimes  foon- 
er,  fometimes  l^ter,  clofes  the  fcene.  There  are 
fome  who  have  died  fo  early  as  within  twenty  four 
hours  after  the  firft  attack  ;  but  the  eleventh  from 
the  firft  feizure,  is  faid  to  be  the  day  on  which  the 
patient  moft  commonly  dies,  though  others  have 
Jived  many  days  longer  without  recovery. 

This  difeafe  was  well  known  to  Hippocrates*, 
and  to  numberlefs  authors  who  have  written  fince 
his  time,  and  has  been  filled  either  epidemic^, 

malignant, 

*  Hipp,  de  Morb.  Mulierum,  lib.  i..fe£t.  5. 
r—  on  Epidemical  Difeafes,  cafe  4  and  5. 

*'  \  During  the  prevalence  of  epidemic  fevers,  the  recovery  of  women  in 
child  bed  is  much  more  precarious  than  in  healthy  feafons.  This  is  obfcrva- 
ble  in  every  fphere  of  life,  but  for  obvious  reafons,  more  remarkably  in  ly- 
ing in  hofpitals  ;  it  has  been  taken  notice  of  by  the  induftrious  Dr.  Syden- 
bam;  and  by  Tho,  Bartholine,  and  muft  undoubtedly  have  happened  invaria- 
bly 


fig  PUERPERAL    FEVER. 

malignant,  putrid,  or  inflammatory,  and  by  fome  a 
compound  of  all  four.  It  is  generally  malignant 
and  putrid,  when  fuffered  to  run  its  courfe,  and  fre- 
quently at  fome  feafons  epidemic,  and  in  fome  fitu- 
ations  may  properly  be  faid  to  be  endemic.  Nay, 
if  the  womb  has  been  lacerated,  or  has  received  any 
injury  in  labour,  it  is  fometimes  undoubtedly  com- 
pounded of  all  five.  Some  have  reprefented  it  as 
entirely  owing  to  the  milk,  fome  to  an  inflammation 
of  the  womb  t,  and  many  to  a  fuppreflion  of  the 

lochia  • 

bly  in  all  ages  of  the  world,  though  it  is  now  better  underftood  in  this  coun- 
try, fince  fome  of  the  moft  ingenious  of  our  phyficians  have  devoted  their 
time  chiefly  to  the  ftudy  and  praftice  of  midwifery,  and  the  management  of 
thofe  difeafes  with  which  it  is  more  particularly  connected." 

Millar  on  the  prevailing  diforders  of  Great  Britainj  pt.  3,  fed.  1.  p.  332  of 
the  puerperal  fever. 

"  Nonnunquam  poft  lochiorum  fuppreflionem  in  febrem  incidunt  puer- 
peras,  quas  vel  in  earum  qua?  turn  graflantur  epidemicarum  caftra  tranfit,  vel 
ab  ea  fola  pendit  origine." 

Diflert.  Epift.  ad.  Gul.  Cole,  M.  D.  Sydn.  op.  p.  5gz. 

t  Tiflbt  in  his  Avis  au  Peuple,  Eng.  edit,  by  Kirkpatrick,  p.  371,  feeras 
to  think  that  this  diforder  is  an  inflammation  of  the  womb,  and  he  mentions 
an  extraordinary  circumftance  not  taken  notice  of  by  other  authors,  viz.  that 
the  belly  turns  black.  Seft.  370,  he  fays,  »  The  inflammation  of  the  womb  is 
difcoverable  by  pains  in  all  the  lower  parts  of  the  belly ;  by  tenfion  or  tight- 
nefs  of  the  whole  belfy  ;  by  a  fenfible  increafe  of  pain  on  touching  it — a  kind 
of  red  ftain  or  fpot  that  mounts  to  the  middle  of  the  belly,  as  high  as  the  na- 
vel, which  fpot  as  the  difeafe  increafes  turns  black,  and  then  is  always  a  mortal 
fymptom  ;by  a  very  extraordinary  degree  of  weaknefs  ;  an  aftoniming  change 
cf  countenance  ;  a  light  delirium  or  raving  ;  a  continual  fever,  with  a  weak 
sod  hard  pulfs ;  fometimcs  inceflant  vomitings  j  a  frequent  hiccup ;  a  mod* 

crate 


PUERPERAL    FEVER,  ^ 

jochia;  fome  have  ranked  it  amongft  hyfterical* 
diforders,  and  others  have  called  it  only  a  fymptom, 
but  all  have  agreed  in  its  fatality  §,  and  the  uncer- 
tainty of  every  method  of  cure,  both  in  the  rich, 
and  in  the  poor,  who  all  acquire  this  diforder  from 
fimilar  caufes,  though  by  means  fomewhat  different. 
I  am  informed  that  the  appearances  after  death,  are 
thofe  of  inflammation  and  gangrene  in  the  intef- 
tines,  or  fome  of  the  abdominal  vifcera ;  fometimes 
in  the  uterus  || ;  and  in  fome  cafes,  when  the  dif- 

eafe 

crate  discharge  of  a  reddifti  ftinking  fharp  water  ;  frequent  urgings  to  go 
to  (lool  ;  a  burning  kind  of  heat  in  the  urine ;  and  fometimes  an  entire  fup- 

preflion  of  it." 

% 

*  "  Fcmina  xxx.  annorum  temperament!  fanguineo-melancholici,  hyftcrici* 
paflionibus  in  puerperio,  &  extra  illud,  fsepins  obncoria,  tcrtium  gravida,  gef- 
tationis  tempore  nee  venae  feftionem  admifit,  nee  exquifite  fervavit  praecepta 
diaetetica.  Primis  poft  partum  diebus  non  bene  purgata  eft  utero  :  Sed  de 
dolore  lumborum,  torrninibus  ventris,  alvo  adftrifta,  &  fomno  per  aliquot 
no&es  inquieto  conquerebatur,  A  praftico,  quern  in  confilium  vocavit,  val~ 
idiores  effentias  ad  pellenda  lochia  fuerunt  data: ;  &  ad  alvum  aperiendara 
uncia  dimidia  falis  amari  Sedlicenfis  in  aqua  fimplici  foluta  eft  oblata.  Inde 
auftis  torrninibus,  nee  fa£la  per  alvum,  nee  per  uterum  excretione,  converfo 
fanguinis  verfus  fuperiora  motu  dcliravit,  &  accedentibus  convulfionibus  ex- 

tinfta  eft," 

Hoffman,  Tom,  3,  feft,  i.  cap.  5, 

obf.  10  de  nialo  Hyfterico, 

§  ««  As  the  difeafe  which  is  the  fubjeQt  of  this  Effay  occafions  the  doth  of 
much  the  greater  part  of  women  who  die  in  child  bed,  &c," 

Deuman  on  the  Puerperal  Fever,  p.  t. 

fl  Pouteau  in  his  Melanges  de  Chirurgie,  p,  i&a,  upon  opening  two  wom«n 
wh<i  died,  tf  this  fever  iin  (their  lying  is  «  the  Hofpital  at  Lyons,  fays, 


Bo          PUERPERAL   FEVER. 

cafe  has  been  of  long  continuance,  it  has  extended 
to  the  lungs,  and  all  the  neighbouring  parts. 

In  the  cavity  of  the  abdomen  is  generally  found 
an  extravafated  ferum,  mitfed  with  purulent  mat- 
ter, and  an  exfudation  appears  upon  the  furface  of 
the  inteilines,  gluing  them  to  one  another,  and  to 
the  peritonaeum.  There  is  no  wonder  that  thefe 
appearances  fhould  be  obferved,  more  particularly 
in  the  abdomen,  as  the  very  acrid  putrid  flools  void- 
ed in  this  diforder  muft  naturally  tend  to  inflame, 
and  to  give  a  putrefcent  difpofition  to  the  inteflines 
by  tranfuding  their  coats,  or  being  abforbed  into 
their  fmall  veflTels  ;  and  we  may  conclude,  that  the 
fame  caufes  which  produce  putrefaction  in  the  ab- 
df)men  of  a  dead  body  *,  fooner  than  in  any  other 

part, 

ct  En  ouvrantccs  matrices  II  ce  prefenta  dans  Tune  &  dans  1'autre  une  circon- 
flance  qui  merite  attention  ;  la  tunique  interne  de  ce  vifcere  etoit  noire  &. 
molle  :  la  matrice  dans  fon  epaiffeur  avoit  une  rougeur  Hvide  &  vraiment 

gangreneufe." 

t 
*  Sir  John  Pringle  gives  us  the  following  note,  which  he  informs   us  he 

had  from  Doctor  Hunter.  "  That  the  abdominal  vifcera  and  mufcles  cor- 
rupt the  fooneft  of  all  parts  in  the  body  after  death,  wherefore  it  is  a  rule 
with  anatomifts  to  begin  their  diffeftions  and  demonftrations  with  thofe  parts 
tvhich  firft  become  oflenfwe.  That  the  quick  putrefaction  here  may  reafon- 
ably  be  afcribed  to  the  putrid  fteams  of  the  faeces  with  which  all  thofe  parts 
are  more  or  lefs  impregnated,  hence  too  the  caufe  of  the  fpeedy  corruption 
of  the  pfoas  and  iliacus  internus  in  comparifon  of  the  mufcles  in  the  extrem- 
ities. That  next  to  the  abdominal  vifcera  and  adjacent  parts,  the  lungs  are 
commonly  fooneft  tainted,  whether  from  the  air  ftagnating  in  the  veficul* 
bronchiales,  or  fome  remains  of  the  perfpirable  matter  that  may  aft  as  a  fer- 
ment, and  haften  the  putrefaction.  For  whoever  tries  the  experiment  of 
compreffing  the  thorax  in  a  body  that  has  been  dead  fome  time>  will  be  fen* 

fible 


PUERPERAL    FEVER.  31 

part  will  alfo  operate  in  the  fame  manner  in  the  liv- 
ing body,  wherefoever  there  is  a  general  putrefa&ive 
tendency  ;  nor  need  we  be  furprifed  that  the  womb 
itfelf  mould  be  found  in  a  gangrenous  flate  when 
we  confider  the  great  diflenfion  it  has  undergone, 
and  that  it  has  afterwards  fuddenly  collapfed,  and 
has  been  kept  fome  time  imbued  with  the  ftagnat- 
ing,  acrid,  or  even  putrefcent  lochia. 

It  does  not  appear  that  this  diforder  can  be  af-  • 
cribed  to  fimple  inflammation.  The  patients  com- 
plain chiefly  of  a  tenfion,  forenefs  and  tendernefs 
of  the  lower  part  of  the  belly,  and  are  not  conftant- 
ly  affected  with  thofe  excruciating  pains  which  gen- 
erally attend  common  inflammations  of  the  bow- 
els ;  but  it  frequently  manifefls  itfelf  to  be  of  a  ma- 
lignant kind,  occafioned  by  abforption  of  human 
effluvia,  of  acrid  bile,  and  of  a  putrid  colluvies 
through  the  whole  inteftinal  canal  and  organs  of 
generation* 

Scarce  any  two  authors  have  defcribed  this  fever 
alike,  and  yet  I  believe  their  defcriptions  have  truly 
been  from  what  they  have  feen,  but  thefe  different 
appearances  have  been  probably  owing  to  a  variety 

of 

fible  of  the  putrid  ftate  of  the  lungs  by  the  offenfwenefs  of  the  air  that  ia 
forced  out  of  them." 

On  the  Difeafe*  of  the  Army,  Appendix,  p,  84,  ^to.  edit. 


32          PUERPERAL   FEVER. 

of  management,  and  to  a  difference  in  theconftitu* 
dons  of  the  patients. 

Though  a  true  puerperal  fever  is  originally  cauf- 
ed  by  a  putrid  atmofphere,  or  too  long  a  'confine- 
ment of  the  patient  in  an  horizontal  pofition,  pro- 
ducing an  abforption  of  putrid  or  acrid  matter, 
and  is  not  occafioned  by  either  the  heat  of  the  air, 
or  any  hot  things  taken  internally ;  yet  it  may  be 
much  aggravated  by  thefe ;  and  many  of  the  fymp- 
toms frequently  attending  it,  are  entirely  occafion- 
ed by  the  hot  air  and  a  hot  regimen.  For  inftance, 
if  a  woman  of  a  ftrong  conflitution,  and  of  a  pleth- 
oric habit  of  body,  be  feized  with  this  fever,  and 
fpiritucus  liquors  and  hot  fpices  be  given  her,  me 
will  have  a  ftrong  hard  pulfe,  and  the  fypmtoms 
cf  inflammation  will  run  fo  high  as  to  indicate  the 
neceflity  of  copious  bleeding ;  and  when  the  fever 
is  farther  advanced,  a  delirium;  fubfultis  tendinum, 
&c.  will  come  on.  But  if  the  patient  be  of  a  more 
relaxed  habit  of  body,  and  be  kept  fweating  in  bed 
in  a  warm  room,  by  warm  liquids,  eruptions  will 
appear  upon  the  fkin  ;  and  if  a  woman  fubje6l  to 
hyfterical  complaints  be  feized  with  this  fever, 
and  have  any  large  evacuations  either  naturally,  or 
procured  by  art,  a  train  of  hyflerical  fymptoms 
will  fucceed.  And  laftly,  it  muft  be  obferved  that 
though  all  the  fymptoms  here  enumerated  have 
been  feen  in  different  patients,  yet  it  muft  .not  be 

imagined 


PUERPERAL    FEVER.         gj 

imagined  that  all  of  them  ever  occurred  in  the  fame 
fubjea*. 

*  The  opinion  of  the  royal  medical  fociety  of  Paris,  held  at  the  Louvre, 
the  6th  of  Sept.  1782,  as  given  in  the  report  of  a  memoir  of  Mr.  Doulcet  oa 
the  method  of  treating  the  puerperal  fever  -,  which  was,  in  1783,  tranflated 
into  Englifh  by  Dr.  Whitehead,  phyfician  to  the  London  Difpenfary,  with 
the  addition  of  many  valuable  notes,  confirms  the  theory  I  have  endeavour- 
ed to  advance  on  this  fubjeft.  "  But  without  entering  into  long  difcufiona 
*'  oo  this  fubjeft,  which  would  require  deeper  refeaYches  than  the  time  and 
*'  limits  of  this  report  will  permit,  we  will  content  ourfelves  with  obferving, 
<;  that  all  the  defcripdons  we  have  of  this  difeafe,  which  are  numerous,  pre- 
"  fent  it  under  two  principal  characters,  lB5t  is>  as  an  highly  inflammatory, 
*'  and  as  a  putrid  difeafe.  The  inflammation  is  announced  by  the  tendon 
"  and  pain  oT  the  belly;  and  the  putridity  is  evidently  marked  by  the 
"  weaknefs  and  fmallnefs  of  the  pulfe,  the  proftration  of  flrength,  and  the 
"  exceiTiver  foetid  evacuations.  The  rriorc  the  putrid  character  prevails,  the 
'*  more  rapid  and  dangerous  the  difeafe  appears  in  general.  The  obferva- 
"  tions  of  Johnfon,  Johnftone,  and  De  la  Roche,  reprefent  it  as  being  m«re 
"  of  an  inflammatory  nature,  and  at  the:  fame  time  not  fo  alarming  ;  thofe 
*'  rt'f  White,  Leakc,  and  Slaughter,  as  the  molt  putrid  and  moft  fatal  difcafe. 
«  Of  four  women  who  were  attacked  with  this  dife^fe  in  the  Hofpice  de 
t{  Vaugirard,  three  had  a  weak  pulfe,  remarkable  profcration  of  flrength, 
'l  and  extremely  foetid  evacuations  ;  and  all  three  died.  The  fourth  was 
"  more  robuftj  and  the  fymptoms  were  fcr  violent  as  to  require  feverai  bleed- 
"*'  ings,  and  fhe  was  the  only  one  who  happily  recovered.  This  proftratioa 
"  of  flrength,  therefore,  which  charafterifes  the  putridity,  is  one  of  th« 
*'  worft  figns  of  this  difeafe.  It  is  chiefly  in  hofpitals  that  it  affumes  this 
t:  characler,  and  it  has  no  where  been  cither  fo  rapid,  or  fo  generally  fatal, 
<{  as  in  the  Ho:el  Dieu,  for  fome  years  pail.  Does  it  in  thefe  cafes  partak« 
l<  of  the  nature  of  the  hofpltal  fever  ?  This  i«  *he  fentiment  of  Mrj  White,'* 
Vid.  Whitehead's  Tranf,  p.  31. 


CHAP. 


34 


CHAP.      II. 


ON  THE  MILIARY  FEVER, 


HOUGH  medical  hiftory  does  not 
with  abfolute  certainty  inform  us 
whether  the  Miliary  Fever  was  ob- 
ferved  amongft  the  ancients,  yet  there 
is  the  greatefl  probability  that  it 
was,  from  federal  paffages  in  Hippocrates*,  Cel- 

fus, 

*  "  O&avo  fudor  frigidus  per  omnia  membra  diffufus  eft,  cum  puftulis 
rubentibus,  rotundis  parvis,  varis  non  abfimilibus,  quse  permanebant  neque 
abfceflum  faciebant.' 

Hipp,  de  Morb.  vulg,  lib.  i.feft.  3«  ccg.  2. 

Per  magnos  sftus  affatim  &  continenter  compluit,  idq;  ab  auftro  magis* 
Sanies  quidem  pluritna  cuti  fubnafcebatur,  quaj  intro  conclufa  dum  incalef- 
ceret,  pruriginem  excitabat.  Deinde  vero  in  puftulas  erumpebat  iis  affines, 
qua  in  ambuftis  fieri  folent. 

Hip.  de  morb.  vulg.  lib.  2.  fect»  i. 

In  febribus  autem  seftivis  circa  feptimum,  oftavum,  &  nonum  diem,  af- 
predines  quzdam  miliace«e,  culicum  morfibus  fere  fimiles,  quas  tamen  non 
a'dmodum  pruriebant,  in  jfumxna  cute  fubnafcefeaatur  &  ad  judicationem  uf- 

que  perdurabant. 

Ibid.  lib.  2.  feft.  3, 
-   Euphjanorb 


M  I  L  I  A  R  Y    FEVER.  35 

fust,  yEtius^,  Haly  Abbas §,  Fernelius||,Francifcus 
Valefius*,  Petrus  Forreftus  t,  Ballonius  J,  and  Sen- 

nertus. 

Euphranoris  filio,  puftuls  culicum  morfibus  non  abfimiles  erupcrunt,ve- 
rum  pauco  tempore  duraverunt,  poftridie  febris  invafit." 

Ibid.  lib.  5. 
t  pc  puftularum  generibus. 

At  puftulas  maxime  vernis  temporibus  oriuntur.  Earum  plura  genera 
funt,  Nam  modo  circa  totum  corpus  partemve  afpredo  quasdam  fit,  fimills 
his  puftulis,  quac  ex  urtica,  vel  ex  fudore  nafcuntur  ;  exanthemata  Grasci  vo- 
cant,  exque  modo  rubent,  modo  colorem  cutis  non  excedunt.  Nonnunquam 
plures,  fimiles  varis  oriuntur,  nonnunquam  majores.  Purtulae,  lividae  fnnt,aut 
pallidas,  aut  nigrac,  aut  aliter  naturali  colore  mutato  :  Subeftque  illis  humor. 
Ubi  has  ruptae  funt,  infra  quafi  exulcerata  caro  apparel,  Phlyftaense  helcodes 
Graeci  nominantur.  Fiunt  vel  ex  frigore,  vel  ex  igni,  vel  ex  medicamentis. 

Cclfus,  lib.  5.  cap.  28. 

t  Fiunt  etiam  aliqxiando  puftulae  rotundae  inequales,  fubalbidae  aut  fubru* 
brs,  cum  elevatione  caronis. 

^tii  Serm,  5.  cap.  129  De  Puft.  in  feb.  cur,  ex  Herod. 

?    . ' 
\  Haly  Abb.  Reg.  Difpof.  Theoric.  lib.  viij.  chap.  xiv. 

|j  Exiguie  &  aquofas  puftulas  funt  hidroa,  id  eft  fudationcs.  Emergunt  fe- 
pente  fparfim  toto  corpora,  fed  frequentius  in  manibus  pedibufque,  milii 
magnitudine,  aqua  pknas,  fine  rubore,  fine  ullo  dolore.  Fiunt  cnim  ex  fu- 
doribus  fub  epidcrmide  cocrcitis,  per  cujus  fpiracula  hi  digeri  minime  pof- 
funt  ;  Unde  a  quibufdam  fudorum  papulae  nuncupantur. 

Fernelii  univerfa  med.  lib.  7,  cap.  5.  p.  242, 

*  FrancifcusValefms  in  Hipp,  de  morb.  vulg.  com.  lib.  2.  left.  3. 

•f  Petrus  Forreftus  obf.  59.  p.  205.  lib.  6.  vol.  I.  De  Purpura  intus  re- 
percuffa.  Obf.  60  De  Purpura  papulas  rubentes  habente,  Obf.  61  De 
Muliere  fudamina  habente,  &  a  medicaftris  male  traftata  unde  tandem  mora 
fubfecuta  eft. 

Ij.  Antequam  cahdis  ifte  invafiffet  viris  &  majoribus  apparcbant  maculz, 
cchthymata,  Miliares  puftulae  et  caetera,  id  genus  idque  «eftate  maximi,  fed 
nullum  id  adferebat  perkulum. 

G.  Ballon.  Epid.  &  Eph.  lib.  2.  p.  202. 
Conftiiutio  autumnalis.  A.  D.  1577. 
C  e 


36  M  I  L  I  A  R  Y    F  E  V  E  R, 

nertus§.  It  is  evident  that  it  was  known  to  Riverr- 
us  |l  3  who  does  not  fpeak  of  it  as  a  new  difeafe.  But 
we  have  no  accurate  defcription  of  it  till  the  middle 
of  the  la  ft  century  *,  when  it  was  fir  ft  obferved  in 

the 

$  Verum  cum  Exanthcmatum  genus  duplex  fit,  unum,.  quodcolorem  cutis 
faltem  mutat,  ut  fit  in  febribus  petechialibus,  alterum  in  quo  tubercula  quz- 
elam  in  cute  erumpunt,  puftularum  &  papularum  nomen  non  utrique,  fed 
pofteriori  faltem  generi  congruere  vidctur,  et  papulae  ac  puftulae  faltem  tubcr- 
eula  fignificant,  in  quibus  humor  aliquis  continetur. 

Senert.  Tom.  3,  lib.  5.  p.  i,  cap.  22.  p.  771. 

jl  Exanthemata  a  maculis  purpureis  differunt ;  ex  eo  quod  maculae  ad 
qualitates  mutatas  ipftus  cutis,  cum  nullomodo  emineant ;  exanthemata  vero 
ad  tumorum  genera  refcruntur.  Sunt  enim  varorum  inftar  aliquando  alias 
vero  minora,  granis  milii  fimillima.  Aliquando  rubra  funt  a  fanguine 
genita  ;  aliquando  alba,  a  pituita,  vel  fero  ;  flava,  a  bile  ;  punicea,  a 
bile  exufta  ;  livida  vel  nigra,  a  maxima  exuftione,  vel  mortificatione.  Qu;s- 
<lam  fymptomatice,  quaedam  criticc,  queedam  mcdio  modo  erumpunt.  Alia 
tecficcantur  fimpliciter,  alia  fuppurantur,  alia  ukerantur. 

Laz.  River.  Prax.  Med.  lib.  17.  feft.  3. 
cap.  i .  de  febre  peftilenti. 

*  Gottofredus  Welfchius  Lipfienfis,  Chirurgiae  &  Anatomicas  Prof.  pub. 
Hift.  Med.  Puerperarum  morb.  continens,  qui  ipfis  dcr  Frierfil  dicitur  &  (Fe- 
Mis  eft  maligna  Miliaris)  Lipf.  1655  Chrift.  Johannis  Langii  Prax.  Med» 
cap.  13.  de  febribus  feft.  9  de  Purpura,  &  torn.  3.  p,  351. 

Georg.  Hieronym.  Velfch.  curat.  Med.  Decad,  i  curat  ij  Febris  Coecinea 
in  Puerpera. 

Carol,  Rayger.  inMif.  nztur.  cur.  ann.tertii  de  febre  malign,  cum  Exanth. 
Miliar.  obf.  281,  p.  496. 

Mich.  Etmulleri  oper,  Med,  Theoret,  Praft.  tom.  2,  cap.  17,  art.  3,  p» 
1047 — De  Purpuva,  feu  febre  Miliavi  Puerperarum. 

Jof.  Nichol.  Pcchlin,  obf|  Pbyf.  Med,  lib.  2.  p,  ?^§,  ubf,  19  Exanthema* 
ta  cwm,  &  fine  fcbrc. 


MILIARY    FEVER,  3y 

the  city  and  neighbourhood  of  Leipfic  in  Germany* 
It  began  amongft  puerperal  women  without  diftinc. 
tion  of  age.  It  foon  fpread  itfelf  all  over  Germa- 
ny, and  proceeded  to  other  countries.  The  faga- 
cious  Sydenham*,  obferved  it  firfl  in  England  in 
Feb.  1685.  According  to  his  account  it  began  in  a 
thaw,  after  the  breaking  up  of  a  froft,  which,  though 
fevere,  had  not  continued  fo  long,  nor  had  been  fo 
intenfe  as  that  of  the  preceding  year. 

A  variety  of  Authors  |[  who  have  written  on  this 
difeafe  have  differed  greatly,  not  only  with  regard 

to 

*  Sydenham.  Sched.  Monit  de  novae  febris  ingrefiu,  p.  643. 

j]  Sir  David  Hamilton  de  febre  miiiari,  Boettigeri  difiert.  de  purpura  nibra 
epidemic,  J.  White,  M.  D.  de  re£a  fanguinis  miffione,  or  new  and  exacl: 
obfcrvations  of  fevers.  Sir  Richard  Blackmore  on  the  plague.  Juncker. 
confpeft.  Medicin,  tab.  74,  p.  596.  Allen.  Synops.  art.  1497,  &c.  Ful- 
ler on  eruptive  fevers,  purple  fever,  p.  130,  Miliary  fever,  p.  157.  Hoff- 
man de  febre  purpurata  rubra  &  alba  miliari,  torn.  2,  fe&.  i.  cap.  9.  p.,68* 
James's  dift.  art.  purparea.  Huxham's  Eflay  on  fevers — On  the  Ulcerous 
Sore  Throat — Obf.  de  acre.  Mead  Monita  Med.  Levret  L'art  des  aocouch. 
Van  Swieten'*  Comment,  or  Boerhaave's  Aph,  fe&,  723^  982,  Ant.  de  Haen 
traft.  de  febrium  divifionibus.  Dr.  Storck's  Bienn.  Med.  Heifter's  Obferv. 
obs.  183,  356,  475,  583. — Compend  of  Phyfick,  p.  125,  424.  Home's 
Medical  Fafts.  Pringle  on  the  Difeafes  of  the  Army.  410  edit.  Edinburgh 
Effays,  phyf,  and  lit,  vol.  2.  Sir  Richard  Manningham  on  the  Febricula.  p. 
116.  Allionius  Traft.  de  Miliarum  progveiTu.  Lieutaud.  Synops.  Univer* 
Pn  Med.  Febri s Mi/iaris  Putrperarum,  p.  476.  J.  Fordyce  Hift.  Peb.  Milia- 
vis.  The  Cure  of  the  Miliary  Fever  by  a  fubjecl  of  Mithridates,  king  of 
Pontus.  Baker's  Obf.  on  the  prefent  epidemical  Fever,  Glafs's  Commen- 
taries on  Fevers,  p.  170.  Denman  on  the  puerperal  Fever,  p.  48.  Johnbn'a 
Midwifery,  p.  366.  Smeiiie's  Midwifery,  vol.  i.  p.  42,0.  Hafenorhl  Hift, 
riic-  p.  5.  Haller  Phyfiol,  voi,  2»  p.]  §93*  EngUfh  edit. 


38  MILIARY    FEVER. 

to  its  nature  and  caufe,  but  in  refpeft  to  its  fyrnp- 
toms  and  method  of  cure.  Some  have  afferted  that 
it  is  a  fever  fui  generis,  and  that  the  eruption  is  crit- 
ical ;  others  that  it  is  a  creature  of  our  own  mak- 
ing, and  that  the  eruption  is  produced  entirely  by 
the  ufe  of  too  hot  medicines  ;  others  again  are  of 
opinion,  that  the  miliary  eruption  is  critical,  but 
allow  that  an  eruption  fimilar  to  this  may  be  pro- 
duced by  fweating,  yet  do  not  give  us  any  criterion 
how  they  are  to  be  diltinguifhed  ;  others  likewife 
fay  that  this  difeafe  is  not  always  terminated  by  any 
one  fort  of  crifis.  Some  fay  that  the  eruption  is 
red,  others  that  it  is  white  or  pearl  coloured,  cryfta- 
line  or  veficular,  and  that  the  red  eruption  is  only 
a  fimple  raft.  Some  mention  two  forts,  red  and 
white,  and  when  both  appear  together,  call  the  dif- 
eafe compound  ;  an  appellation  which  others  ap- 
ply when  it  attacks  pregnant  or  puerperal  women, 
or  is  complicated  with  other  diforders.  Some  al- 
lege that  it  chiefly  attacks  weak  and  exhaufted 
perfons,  fome  that  it  attacks  thofe  of  a  bilious  con- 
ftitution,  others  that  it  feizes  all  indifcriminately. 

Authors 

by  Mihles.  Med.  Obf.  &  Inq.  vol.  4«p,  29,  in  a  paper  on  the  Seltzer  wa- 
ter, by  Dr.  Brocklefby.  Commercium  literarum  for  the  year  1735.  Bu- 
chan's  Domeftic  Medicine,  p.  244.  574,  Lobb's  Practice  of  Phyfick,  vol.  2. 
p.  141,  Brooke's  Pra&iceof  Phyfic,  vol,  i.  p.  181.  Mem.  del'Acad.  des 
Sciences,  1'an,  1747.  Macbvide's  Experimental  Effays,  p.  192.  Lind's  pa- 
pers on  Fevers,  p,  86.  106.  Etherington's  general  Cautions  in  Fevers,  chap* 
£.  p.  50.  Dr.  Piniard's  Account  of  the  £pidem'~  Difeafe  which  raged  at 
Rouen  in  1753.  Dr.  Wall's  Accoupt  of  the  Ulcerated  ?ore 
Mufeum,  vol.  i.  p.  119, 


MI  LI  ARY    FEVER.  39 

Authors  have  varied  much  as  to  the  time  when  the 
eruption  appears,  fome  have  perceived  it  as  early 
as  the  fifth  day,  fome  on  the  feventh,  or  eighth, 
others  on  the  tenth  or  eleventh,  and  others  again 
as  late  as  the  fourteenth,  fifteenth,  and  fixteenth, 
and  even  on  the  twenty  eighth,  as  I  have  been  in- 
formed ;  whilft  fome  have  declared  that  no  precife 
time  can  be  afcertained  for  its  appearance.  How- 
ever, they  feem  to  agree  in  fome  particulars  ;  as, 

That  puerperal  women  are  peculiarly  liable  to  it. 

. 

That  it  is  a  difeafe  of  a  malignant  or  putrid  ten- 
dency. 

That  the  eruption  is  promoted  by  fweating  in 
bed,  and  is  the  moft  plentiful  on  thofe  parts  of  the 
body  which  have  fweated  the  moft. 

That  the  puftules  at  laft  come  out  with  a  gentle 
and  continued,  or  a  copious  and  profufe  fweating  ; 
but  that  thefe  profufe  fweats  are  not  critical,  what- 
ever the  eruption  may  be. 

That  patients  arefubjeft  to  more  crops  than  one. 

That  miliary  eruptions  have  however  been  known 
at  different  times  to  accompany  inflammatory  fevers, 
and  moft  of  the  diforders  incident  to  the  human 

body. 

• 
That  a  happy  event  does  not  depend  either  upon 

the  largenefs  of  the  quantity,  or  the  earlinefs  of  the 
C  4  eruption  j> 


4$  MILIARY    FEVER. 

eruption  ;  but  that,  on  the  contrary,  the  fuller  and 
tfye  earlier  the  eruption  is,  the  greater  is  the  danger. 

Allionius,  a  Phyfician  of  eminence  at  Turin,  has 
treated  of  this  diforder  more  fully  than  any  other 
writer  ;  and  from  his  account  the  following  cir* 
cumftances  are  extracted,  which  prove  the  affinity 
of  the  miliary  fever  with  putrid  difeafes  in  general. 

"  It  may  be  traced  to  the  fame  caufes  which  pro- 
duce putridity  in  general,  and  the  difeafes  confe- 
quent  upon  it. 

£C  A  miliary  eruption  often,  accompanies  putrid 
and  other  eruptive  fevers. 


*'  Though  women  in  child  bed  are  generally  firft, 
and  more  univerfally  attacked  by  it,  it  is  not  con- 
fined to  them  alone. 

: 

"  Moft  things  that  are  ufeful  and  noxious  m  pu-» 
trid  fevers,  are  the  fame  in  this." 

) 

If  we  next  confider  the  fymptoms  of  the  miliary 
fever,  we  mail  ftill  find  a  great  fimilarity  with 
thjofe  of  other  putrid  difeafes  ;  infomuch  that  there 
feems  to  be  no  pathognomonic  fign  of  this  difeafe, 
except  the  eruption  be  allowed  to  be  one.  The 
great  anxiety,  vaft  oppreffion,  fighing  and  dejection 

of 


MI  LI  AX  Y    I  EVER. 

of  fpirits,  fo  much  in  fitted  on  by  all  author, 
tfee  pathognompnic  fymptoms  of  all  putrid  difeafes 
in  general.  They  are  the  attendants  of  the  low> 
nervous,  the  putrid  malignant,  and  of  all  petechi- 
al  fevers  ;  and  fo  indeed  is  the  thrum,  loofenefs, 
pale  urine,  and  the  quick  and.  weak  pulfe. 

Some  have  faid  that  the  tenfion  and  tendernejfe 
of  the  abdomen  are  pathognomonic  fymptoms  of  thfc 
puerperal  fever,  but  others  have  found  them  in  the 
miliary*.  The  reft  of  the  fymptoms,  are  common  to 
all  fevers  whatever.  The  difeafes,  or  rather  the 
fymptoms,  which  are  faid  to  fucceed  the  miliary 
fever,  are  he&ic  heats,  lofs  of  appetite  and  of  fpir- 
its, and  fwellings  of  the  legs,  feet,  and  thighs;  but 
thefe  are  nothing  more  than  whatlfollow  other  pu- 
trid fevers. 
' 

Thofe  who  have  had  this  fever,  are  particularly 
liable  to  returns  of  it  during  their  whole  lives ; 
owing  mod  probably  to  the  fkin  being  over  relaxed, 
and  its  tone  deftroyed,  by  a  too  liQt  and  forcing 

treatment. 

To 

*  "  The  tenfion  and  tendernefs  of  the  abdomen  have  been  laid  down  as 
pathognomonic  fymptoms  of  this  difeafe.  1  myft  confefs  my  doubts  in  this 
jppint,  for  I  have  met  with  them  early  in  the  month  of  child  bed,  the  patient 
being  feverifh  at  the  fame  time,  and  yet  as  appeared  to  me,  the  complaints 
arofe  only  from  an  accumulation  of  indigefted  aliments  in  the  primae  vise ; 
fmce  by  giving  a  purgative,  which  brought  away  a  large  quantity  of  very 
putrid  fceces,  they  were  entirely  removed.  Befides,  they  are  to  be  found  in 
a  miliary  fever,  as  will  be  flicwn  ia  the  next  chapter." 

V  Midwifery;  p»  35°* 


4*s  MI  LI  ARY    FEVER. 

To  what  has  been  already  faid  I  muft  beg  leave 
to  add  my  teflimony  that  I  have  frequently  feen  in 
puerperal  women,  miliary  eruptions  both  of  the 
red  and  the  white  kind,  without  any  fever  fuper- 
vening,  a*id  totally  unattended  with  danger ;  and  I 
have  feen  all  the  fymptoms  of  the  miliary  fever  (as 
they  are  generally  defcribed  by  authors)  except  the 
eruption,  and  yet  the  diforder  has  terminated  hap- 
pily, and  in  a  fhort  time,  without  that,  or  any  other 
particular  crifis. 

Some  years  ago  this  do&rine  might  have  been 
treated  as  chimerical,  but  now  I  do  not  doubt  I  (hall 
eafily  gain  credit,  as  every  inoculator  knows  that 
even  the  fmall  pox  itfelf,  in  which,  of  all  eruptive 
fevers,  the  eruption  feems  moft  critical,  may  be 
happily  got  over  with  little  or  no  eruption,  and  at 
the  fame  time  the  patient  be  fecured  from  ever  hav- 
ing the  diforder  again. 

That  the  miliary  fever,  like  many  other  putrid 
fevers,  may  be  generated  by  ill  management §3 1  have 
not  the  leaft  doubt ;  and  the  relation  of  the  follow- 
ing incident  may  help  to  prove  the  affertion. 

When 

§  Do&or  Shebbeare,  though  no  friend  to  the  cool  regimen,  fays, "  The  moft 
effedual  way  is  to  fupport  the  vital  heat  by  the  gentleft  means,  and  in  an 
equable  manner,  otherwise  the  miliary  eruption  may  be  raiher  a  fymptom  of 
the  PhyQcian  than  of  the  diforder,  as  it  is  to  be  feared  that  fome,  through 
miftaken  practice,  have  difcovered  a  way  of  making  miliary  fevers,  and  may 
be  called  a  kind  of  manufacturers  of  that  difeafe  ;  increafed  fweating,  and 
long  continued  heat,  often  exhibit  that  phenomenon,  where  no  ficknefs  at- 
tends," 

Practice  of  Phyfic,  vol.  2,  p,  144* 


MILIARY    FEVER.  43 

When  I  began  to  praftife  midwifery,  a  midwife 
(fince  dead)  had  for  a  long  time  been  in  poffefiion 
of  great  pra&ice  amongfl  all  ranks  of  women,  and 
in  other  refpe&s  was  tolerably  fuccefsful ;  but  a  re- 
markable number  of  women  under  her  care  were 
affecled  with  the  miliary  fever,  which  proved  fatal 
to  many,  particularly  the  wives  of  feveral  of  our 
principal  tradefrnen,  and  became  fo  alarming  and 
notorious,  both  in  this  neighbourhood,  and  in  dif- 
tant  parts  of  the  country,  as  to  acquire  the  name 
of  the  Manchefter  fever. 

Her  method  was  to  keep  her  patients  very  clofe 
and  warm,  fo  as  fcarcely  to  admit  a  breath  of  air  in- 
to the  room,  and  to  confine  them  many  days  fweating 
in  a  bed  in  a  horizontal  pofition.  At  the  fame  pe- 
riod of  time,  and  in  the  fame  town,  other  practition- 
ers who  purfued  a  different  plan  met  with  no  fuch 
fever. 

My  Father  informed  me  that  he  attended  the 
third  wife  of  a  gentleman  who  had  loft  his  two  for- 
mer wives  by  miliary  fevers  in  their  firft  lyings 
in.  This  lady  being  much  alarmed  at  the 
fate  of  her  predeceffors,  was  during  her  con- 
finement continually  upon  the  watch,  to  fee  if 
Die  could  difcover  an  eruption,  which  at  lafl  fhe 
did.  This  difcompofed  her  very  much.  She  made 
a  large  quantity  of  pale  urine.  Both  my  Father 
and  another  Phyfician  who  was  afterwards  called 

in, 


44  MILIARY    FEVER. 

in,  allured  her  that  it  would  not  be  attended  with 
either  fever  or  danger,  and  that  if  fhe  would 
keep  up  her  fpirits,  and  obferve  a  cool  regimen,  it 
would  be  of  no  confequence,  and  accordingly  fhe 
jfoon  recovered — How  far  fear  might  operate  in  this 
cafe  I  leave  the  reader  to  judge.  My  Father  more- 
over faid.  that  this  was  the  only  cafe  of  a  miliary 
eruption  which  he  had  met  with  in  a  child  b^d 
woman,  where  he  had  attended.from  the  time  of  her 
delivery. 

Several  ladies  who  have  had  dangerous  miliary 
fevers  during  their  former  lyings  in,  and  who  have 
been  in  full  expectation  of  them  again,  upon,  tfee 
fame  occafions  have,  by  obferving  the  directions  I 
have  laid  down  in  this  Treatife,  happily  efcaped 
any  kind  of  child  bed  fever. 

I  have  frequently  feen  miliary  eruptions  attend 
the  fymptomatic  fevers  of  perfons  who  have  under- 
gone fome  principal  operation  in  furgery,  though 
at  that  time  they  feemed  to  be  in  a  perfecl  flate  of 
health,  (excepting  the  local  complaint,  for  which  they 
underwent  the  operation)  and  no  other  reafon  could 
be  afligned  for  this  eruption,  but  the  patient's  being 
of  a  relaxed  habit  of  body,  and  fweatingin  bed.  I- 
have  often  feen- miliary  eruptions  at  different  peri- 
ods, and  under  different  circumftances,  but  I  can- 
not, upon  the  flri&efl  inquiry,  find  that  a  miliary 
eruption 'was  ever  produced  without  a  fweat,  either 

ill 


MI  LI  ARY    FEVER. 

in  a  greater  or  lefs  degree ;  and  yet  we  know  that 
mofl  other  eruptions  will  frequently  come  out  with- 
out a  fweat,  as  the  fmall  pox,  meafles,  fcarlet  fever, 
chicken  pox,  the  rafh  which  attends  the  ulcerated 
fore  throat,  and  many  other  kinds  of  eruptions.  I 
have  often  obferved  that  the  miliary  eruptions  come 
out  firft,  and  there  is  the  greateft  quantity  of  them 
in  thofe  parts  which  are  the  clofeft  covered,  efpecial- 
ly  if  covered  with  flannel. 

*  A  very  ingenious  Phyfician  at  Chefter  informed 
me,  that  the  miliary  fever  had  been  generally  imag- 
ined to  be  endemic  in  the  city  and  neighbourhood 
for  thirty  years  before  he  refided  there,  and  had  car- 
ried off  numbers  of  the  inhabitants  ;  that  the  fever 
was  frequently  of  a  long  duration,  that  he  knew  one 
perfon  who  recovered  after  having  fucceffive  crops 
of  miliary  eruptions  for  three  months.  That  anoth- 
er Phyfician  of  the  place  had  informed  him,  that  he 
had  a  patient  who  lay  ill  of  the  fame  fever  for  fix 
months,  and  died  of  it  at  laft.  That  he  hadknown 
the  miliary  eruption  often  to  accompany  the  rheuma- 
tifm,  and  many  other  fevers,  but  from  obferving 

a 

*The  fame  gentleman  has  favoured  me  with  the  following  note.  **  I  have 
frequently  feen  miliary  eruptions  unattended  with  either  fever  or  danger,  and 
feave  had  patients  attacked  with  fevers  of  the  low  nervous  kind,  fighing,  oppref- 
fion  about  the  prxcordia,  a  propenfity  to  fweat,  and  other  fymptoms  ufually 
preceding  miliary  eruptions,  and  at  a  time  and  place  where  miliary  fevers 
were  common ;  yet  by  a  cool  regimen,  and  guarding  againft  fweats  which  ap- 
peared rather  to  be  fymptomttic  than  critical,  the  patients  recovered 
any  wiliar 


46  MILIARY    FEVER, 

a.  different  method  of  treating  fevers  in  general^lie 
was  fully  perfuaded  that  this  was  a  fabricated  fymp- 
tom,  and  never  had  feen  it  evidently  critical. 

The  teftimony  of  Dr.  De  Haen,  of  Vienna,  is  fo 
important,  fo  flriking,  and  coincides  fo  intimately 
with  the  doctrine  I  mean  to  eftablim,  that  it  is 
with  great  pleafure  I  quote  the  following  paffages 
from  his  works.  *  During  the  fix  years  in  which 
he  had  been  Phylician  to  a  hofpital  that  always 
contained  a  large  number  of  fevers,  he  had  only 
feen  miliary  or  petechial  eruptions  three  or  four 
times  as  the  primary  difeafe,  and  once  as  a  fuper- 
vening  fymptom.  If  this  faft  be  compared  with  in- 
numerable cafes  of  miliary  and  petechial  eruptions 
in  theBienniumMedicum  of  Dr.  Storck,who  attended 
another  hofpital  in  the  fame  city — the  excellent  ef- 
fects of  cool  treatment  will  be  eminently  confpicuous. 

In  the  fame  place  he  allows  that  in  private  prac- 
tice he  fometimes  met  with  epidemic  miiiary  erup- 
tions, but  thefe  not  often. 

He  gives  feventeen  cafes  of  petechial  and  miliary 
eruptions,  mofl  of  the  latter  :  They  are  all  brought 
to  prove  that  thefe  eruptions  are  not  critical,  that 
they  arife  fometimes  from  infe&icn,  that  the  blood 
is  often  fizey  in  thefe  cafes,  that  in  fome  cafes  they 
are  produced  by  clofe.  bad  air,  and  fwealing,  and 

that. 

*Vol.  I.  Chap,  29. 


MILIARY-  FEVER.  47 

that  the  bark  is  an  excellent  remedy  in  thefe  erup- 
tive feversj. 

Forty  pages  are  employed  in  confuting  his  adver- 
faries  concerning  the  caufe,  &c.  of  miliary  and 
petechial  eruptions.  He  aflerts  that  hot  medicines, 
regimen,  and  clofe  warm  rooms,  are  the  caufes 
that  thefe  complaints  are  fo  frequent  at  Vienna — 
that  they  arife  fometimes  alfo  from  miafmata,  or 
many  patients  lying  in  the  fame  room*. 

He  quotes  many  authors  to  defend  his  opinion 
againft  fweating§,  and  hot  medicines,  efpecially 
Sydenham. 

From 


J  ^Egri  ergo  numero  1 7  fpatio  6£  annorum  Petechias,  aut  Miliaria,  aut 
utrumque,  in  nofocomio  praftico  habuerunt,  adeoque  quinque  circiter  omni 
biennio.  Pars  media  horum,  exanthemata,  antequam  ad  me  adfeirentur,  jam 
habuerant ;  pars  altera  iifdem  in  nolocomio  praflico  correpti  funt  ;  ergo  inibi 
fpatio  trium  annorum,  exanthemata  hzc  quatuor  duntaxat  zsgris  eruperunt. 
Omnium  vero  duo  tantum  fuere,  quibus  id  fponte  contigerit  ;  reliquis 
15  aut  contagium,  aut  pravum  regimen,  medendive  methodus,  aut 
combinata;  has  caufz,  exanthemata  produxere.  In  nemine  vero  illorum  ea 
critica  fuifle,  ipfa  cujufque  morbi  hiftoria  abunde  evicit.— Concludo,  fi 
plerifque  asgris  meis,  citra  exanthemata,  integrae  contingant,  felicefque 
crifes ;  tune  exanthemata  ilia,  aliis  medicis  adeo  frequentiffima,  critica  utique 

appellari  non  pofle. 

Vol.  a.  Cap*  i.  p.  13. 

"  *Spatio  decem  fere  annorum 24  homines  exanthematici  in  nofocomio  noftro 
fuere  :  O&o  fcilicet  exanthentate  petechiali,  quos  inter  cum  variolis  una ;  xi 
folo  miliari :  V  utroque ;  eofque  inter  una  cum  peflimis  variolis,  affe6U :  Horum. 
nemo  criticae  eruptionisnotam  fuflinuit." 

Vol.  2.  Cap.  i .  p.  395. 

§  '*  Cramer,  pluries  mihi  narravit,  dum  plura  millia  Boruflbrum  captivorura 
anno  2757  &  1758  fu*  cura  demandati  effent,  inter  300  codem  tempore, 

acute 


4$  M  I  L  I  A  fc  Y    FEVER. 

From  the  foregoing  obfervations  the  following 
inferences  may,  I  think,  be  deduced : 

t.  The  miliary  eruption  of  child  bed  women  is 
frequently  a  fymptom  attendant  on  fevers,  caufedby 
human  effluvia,  and  by  fweating,  and  never  ap- 
pears without  a  fweat  preceding  it. 

2  The  precife  time  for  the  appearance  of  the 
eruption,  cannot  with  tolerable  certainty  be  fixed, 
It  being  common  for  one  crop  to  be  fucceeded  by 
imore,  and  even  fometimes  to  appear  without  any 
fever  attending,  or  fucceeding ;  and,  as  by  removing 
the  difeafe  in  its  early  flage  the  eruption  may  be  to- 
tally prevented,  it  cannot  be  called  critical. 

3.  The  cooling  and  extinguiihing  method  of  cure 
(as  it  is  called)  cannot  prove  prejudicial  in  the  early 

flages 

acute  ut  plurimum,  laborantes,  vix  quatuor  aut  quinque  exanthemata  pafroa 
cfl'c;  illosvero  quatuor vel  quinque, aut  nimium  te&os,  ant  aifteconclufosfc 
*eperiffe,  antequam  fibi  Jjemandarentur  :  Leuca  autem  a  fe  diftanti  pago,  ubt 
aib-imtiomorbi  caiida  methodus  in  ufuerat,  vix  zegrotafiequofquam,  qui  exan- 
themate  non  macularentur  :  A  militibus  in  incolas  contagium  tranfiiffe  ;  pluref* 
^uc,una  cum  medico  fuo,exanthematumgenitore,inoT  tern  occubuifle."  p.  421. 

Miliaria  hoc  anno  in  nofocomio  nulla.  An  quod  extinfta  Viennic  ?  Mi&-» 
trne^fcd  quod  eatlem  non  fabriceraus. 

Tom.  3*  p.  43,  Cap.  iij.  de  Miliaribus  1765, 

Trai)i-i?:,cum  bono  Deo  itcrnm,  pro  more,  annus  Academicusfine  miliaribus, 
aut  petechiis  ;  cum  in  nofocoinio,  !um  in  urbe,  &;  fuburbiis  npud  zegros  qui 
ihi   ad  rociilia  vocato,   obternpciaiunt  in    tuto  regiminc  in    abftinentia  a 
:r.3;  &  pncicytirrrin  quctidian.i  Iccii  refeflione, 

Cap,  :•;:,  p}  233.  Impr.  A.  D.  :76S, 


MILIARY    FEVER,  49 

flagcs  by  checking  the  eruption,  if  at  the  fame  time 
it  removes  the  caufe  of  the  difeafe  itfelf. 

4  Puerperal  women  are  not  fubjeft  to  this  dif- 
eafe from  any  othfcr  caufe,  but  that  of  their  being 
in  a  flate  much  inclined  to  putridity,  attended  with 
a  relaxation  of  the  (kin,  from  fweating  in  bed. 

5.  Therefore  as  the  miliary  eruption  is  never 
produced  without  fweat,  and  as  neither  the  one  nor 
the  other  can  be  faid  to  be  ftriftly  critical,  may  we 
not  conclude  that  the  eruption  is  occafioned  by  the 
cuticular  fecretions  being  increafed  by  warmth  and 
relaxation,  and  of  courfe  rendered  more  acrid,  fo 
that  by  lodging  upon  the  fkin,  and  communicat- 
ing with  the  external  air,  they  muft  foon  acquire 
a  putrid  (late,  even  if  the  patient  had  no  figns  of 
putrefcency  before  ? 

In  my  lafl  edition,  I  here  added  fome  annotations 
from  a  manufcript  copy  of  Dr.  Cullen's  le&ure  on 
the  miliary  fever,  as  taken  down  by  Mr.  Bew,  a 
very  ingenious  apothecary  in  Manchefterl  At  that 
time  it  gave  me  no  fmall  fatisfa&ion  to  find  that 
my  ideas  of  this  fever  correfponded  fo  nearly  with 
thofe  of  a  man,  whofe  great  abilities,  both  as  a  pro- 
feffor  and  practitioner,  have  raifed  him  to  the  high- 
eft  degree  of  reputation,  and  who,  from  a  very  ex- 
tenfive  practice,  has  gained  great  experience  :  I  am 
D  happy 


go  M  I  L  I  A  R  Y    FEVER. 

happy  to  find  them  fince  confirmed  by  the  doftors? 
late  publications  on  the  fubjecl;,  in  the  Firft  Lines 
of  the  Practice  of  Phyfic,  vol.  2.  p.  100;  and  in 
the  fecond  volume  of  his  Methodical  Nofology*. 
I  muft  alfo  here  return  him  my  beft  acknowledg- 
ments, for  the  handfome  manner  in  which  he  has 
fpoken  of  me  in  the  latter  of  thefe  publications. 

*  Speaking  of  the  miliary  fever,  he  fays,  "  Quod  nunquam  idiopathieus 
fit,  praeter  opinionem  medicorum,  a  medio  feculi  decimi  ad  hunc  fere  diem, 
omnium,  et  contra  fententiam  medicorum  hujus  aevi,  quorundam  fpe&abil- 
ium,  affirmare  non  aufim  ;  fed  cum  experientiam  in  haec  re  faepe  fallacem,  et 
medicos  plerofque  imitatorurn  fervum  pecusfuiffenoverim,  dubitare  cogor; 
et,  utcunque  fit,  morbum  miliarem  plerumque  fymptomaticum  fuiflc,  ex  ob- 
fervantia  propria,  per  multos  annos  frequenti,  certo  novi.  Nunquam  con- 
tagiofam,  nee  manifefto  epidemicam,  quibufdam  lieet  temporibus  folito  fre- 
quentiorem,  vidi.  Morbis  febrilibus  quibufcunque,  turn  inflammatoriis  turn 
putridis,  aliquando  adjungitur  ;  in  nullis  tamen,  nifi  regimine  calido,£t  fudo- 
ribms  praseuntibus,  ortum,  &.  in  pluribus  regimine  temperato,  et  fudoribus 
vitatis,  morbum^  alias  expeftandum,  prorfus  vitatum  obfervavi,  &c." 

Vid,  Synops,  Nofol.  Method,  vol.  2,  p.  14®. 


CHAP. 


CHAP.      III. 


OF  THE  MILK  FEVER. 


HE  PROXIMATE  CAUSE  of  the  milk 
fever  is  an  accumulation  of  milk 
in  the  breafts,  fo  as  to  occafion 
eonfiderable  tendon,  tumefaction, 
pain,  and  heat  ;  and  if  a  degree 
of  force  be  ufed  to  extra6l  the 
milk  at  a  time  that  the  breafts  are  fo  tenfe  and  tu- 
mefied, inflammation  and  fever  will  be  the  confe- 
quence.  The  tumefaction  will  end,  either  in  ref- 
olution  or  fuppuration,  which  may  happen  in  the 
glandular  or  adipofe  parts  ;  this  will  be  preceded 
by  pains  in  the  head,  in  the  breafts,  and  under  the 
arms,  by  irregular  Ihiverings,  thirft,  inappetency, 
heat,  and  quick  pulfe  ;  the  matter  will  either  find  its 
way  externally,  or  will  be  abforbed,  and  produce 
he&ic  fymptoms.  I  never  knew  it  terminate  in  gan- 
grene, and  feldom  in  fchirrus,  except  from  mifman- 
agement 

Da  The 


52  M  I  L  K    F  E  V  E  R. 

The  REMOTE  CAUSES  may  be  many  and  various; 
as  cold,  which  conftringes  the  diameter  of  the  vef- 
fels,  and  renders  them  impervious  :  plafters ;  fpir- 
ituous,  or  hot  applications  to  drive  back  the  milk ; 
a  hot  room  ;  too  many  clothes ;  error  in  diet,  either 
in  quantity  or  quality  ;  violent  efforts  to  draw  out 
the  nipples  from  the  breafts,  when  they  are  in  fuch 
a  faulty  flate  as  to  render  this  difficult  ;  and  too 
fudden,  or  too  early  a  floppage  of  the  blood  from 
the  uterine  veffels,  which,  by  the  analtomofmg  of 
the  epigaftric  arteries,  fills  the  internal  mammary 
arteries  too  fuddenly,  before  the  lactiferous  tubes 
are  become  fufficiently  pervious. 

' 

The  PREDISPONENT  CAUSES  of  the  fever  are  fuch 
a  firmnefs  and  impervioufnefs  in  the  lactiferous 
tubes,  in  an  irritable  habit  of  body,  as  to  impede 
and  obftrucl;  the  flow  of  milk  into  the  breafts, 
whence  alfo  it  is  always  moft  violent  in  the  firfl 
lying  in. 

The  fmall  flat  nipple  which  lies  buried  in  the 
bread  is  generally  occafioned  by  the.  tight  drefs, 
which  has  for  fome  centuries  been  fo  conflantly 
worn  in  this  ifland  by  the  female  fex  of  all  ages,  and 
of  almoft  all  ranks,  the  moft  laborious  and  neceffi- 
tous  alone  being  excepted.  This  drefs,  by  con- 
ftantly  preffing upon  the  breaft  and  nipple,  reduces 
it  to  a  flat  form,  inftead  of  that  conical  one,  with 

the 


MILK    FEVER.  53 

the  nipple  in  its  apex,  which  it  ought  to  preferve  ; 
and  the  nipple  is  buried  in  the  breaft.  By  being 
conftantly  kept  in  thi's  pofition,  it  contracts  adhe- 
fions,  it  is  prevented  from  coming  out  ;  the  whole 
breaft  is  deprived  both  of  its  beauty  and  ufe,  and  is 
even  driven  out  of  its  proper  place. 

Parents  cannot  be  too  cautious  in  this  article  of 
drefs.  It  is  a  matter  of  the  greateft  confequence 
to  their  daughters  whenever  they  are  in  a  puerperal 
Hate.  The  tightnefs  of  the  flays  is  alone  fufficient 
to  do  much  harm,  but  they  are  alfo,  often  made 
hard  and  unpliable  by  packthread  and  whalebone, 
which  muft  greatly  increafe  the  mifchief. 

I  will  here  fubjoina  fhort  defcription  of  the  breaft, 
for  the  benefit  of  fuch  of  my  readers  as  may  not 
yet  have  had  proper  opportunities  of  gaining 
information.  The  breaft  confifts  of  a  large  conglom- 
erate circumfcribed  gland,  mixed  with  a  confider- 
able  quantity  of  fat.  The  glandular  fubftance  is 
compofed  of  a  congeries  of  fmall  convoluted  arte- 
ries, veins,  and  nerves.  The  ultimate  arteries,  be- 
fore they  terminate  in  their  correfpondent  veins, 
detach  minute  branches  for  the  feparation  of  the 
milk,  which  uniting  as  they  proceed  to  the  nipple, 
form  fmall  canals,  called  the  laftiferous  tubes : 
thefe  are  about  feven  or  eight  in  number,  commu- 
nicating with  the  bafis  of  the  nipple,  and  general- 

D  3  17. 


54  MILK  FEVER. 

ly  opening  at  its  apex  by  the  fame  number  of  duels, 
though  fometimes  two  of  them  open  by  a  common 
orifice.  The  duds  adhere  to  a  tough  ligamentary 
elaftic  fubftance,  which  is  continued  from  the 
gland,  and  terminates  with  the  du&s  in  the  nipple. 
This  ligamentary  fub fiance  and  thefe  dufts  which  it 
contains,  are  capable  of  extenfion  and  contraction  to 
a  great  degree,  and  in  their  natural  date  are  moderate- 
ly folded,  curled,  or  corrugated ;  by  which  mechan- 
ifm  the  place  of  valves  is  fupplied,  and  the  invol- 
untary eruption  of  the  milk  prevented,  unlefs  the 
diflending  force  be  very  great,  from  the  accumula- 
tion of  too  great  a  quantity.  The  whole  fubftance 
of  the  nipple  is  fpongy,  elaftic,  and  fubjecl:  to  dif- 
ferent changes,  becoming  fometimes  hard,  fome- 
times flaccid,  fometimes  flat,  and  funk  into  the 
breaft,  and  at  other  times  prominent.  Its  outward 
furface  is  uneven,  and  full  of  fmall  tubercles.  The 
nipple  is  furrounded  with  a  difk  or  circle  of  a  dif~ 
ferent  colour,  called  the  areola,  and  on  the  infide 
of  the  {kin  of  the  areola,  are  di Geminated  little 
glands,  known  to  anatomifts  by  the  name  of  feba- 
ceous  glands.  Thefe  fupply  an  oily  mucus,  to 
defend  the  areola  and  nipple  from  that  abrafion 
which  would  otherwife  be  the  confequence  of  fuc- 
tion,  and  likewife  to  glue  up  the  mouths  of  the 
lactiferous  tubes.  The  fkin  upon  thefe  parts  is 
extremely  thin,  and  confequently  the  nervous  pa- 
pilae  lie  very  bare,  and  are  very  liable  to  irritation. 

From 


M  I  L  K    F  E  V  E  R.  K 

From  this  ftructure  of  the  breaft  we  are  enabled 
to  explain  the  reafons  of  the  feveral  phenomena 
of  faction.  Why  the  milk  does  not  flow  fpontane- 
oufly  from  the  breafts  in  all  fabjects.  It  is  pre- 
vented by  the  convoluted  pofition  of  the  ducts,  and 
their  orifices  are  glued  up  by  the  febaceous  juice  of 
the  glands.  Why  the  milk  flows  with  impetus  af- 
ter the  firft  faftion.  The  tubes  are  elongated  and 
unfolded,  the  febaceous  gluten  feparated  from  their 
orifices,  the  ftream  of  milk  keeps  the  tubes  ftraight, 
and  their  channels  free  from  impediment.  By 
faction  the  body  of  the  breaft  is  increafed  in  length, 
and  its  breadth  contracted,  or  in  other  words  the 
whole  is  made  more  conical,  and  thereby  the  milk 
is  prefled  into  the  tubes  at  a  time  when  they  are 
ftraight  and  open. 

The  operation  of  faction  itfelf  depends  upon 
the  principles  of  the  air  pump.  The  air  being  ex- 
haufted  from  the  lactiferous  tubes  by  the  action  of 
the  child's  mouth,  the  preffare  on  their  fides  pro- 
pels the  milk  towards  the  part  whence  the  air  is 
exhaufted,  that  is,  the  nipple,  and  occafions  it  to 
flow  into  the  child's  mouth,  which  is  alfo  exhauft- 
ed of  air. 

Hence  it  will  appear  evident  why  women  of  rank, 
and  thofe  in  the  middle  ftations  of  life,  meet  with 
difficulty  in  giving  fuck  to  children,  and  have  gen- 
D  4  erally 


56  MILK    FEVER. 

erally  more  or  lefs  of  a  milk  fever,  in  their  firfl 
lyings  in,  but  if  they  fuckle  their  children,  and  meet 
wrh  proper  treatment,  have  never  any  afterwards. 
Hence  it  will  appear  why  hard  working,  labouring 
women,  who  a^re  obliged  to  go  very  loofe  about 
their  breads,  generally  make  good  nurfes,  and  that 
too  with  very  little  trouble. 


CHAP. 


CHAP.      IV. 


GENERAL  DIRECTIONS  FOR  THE  PREVENTION  OF 
MANY  DISORDERS  PECULIARLY  INCIDENT  TO 
THE  PREGNANT  STATE. 

H  E  prophylactic  art,  or  the  pre- 
vention of  difeafes,  particularly 
of  fevers,  is  a  fludy  of  the  utmoft 
confequence  to  every  one  who 
pra&ifes  furgery  or  midwifery. 
Without  a  perfect  knowledge  of 
this  branch  of  phyiick,  the  pra&itioner  cannot  hope, 
at  leaft  <he  ought  not  to  expeft,  fuccefs,  either  after 
feveral  of  the  principal  furgical  operations,  or  af- 
ter the  deliveries  of  women,  whether  they  be  natur- 
al, preternatural,  or  laborious. 

As  foon  as  a  woman  has  conceived,  and  a  flop  is 
put  to  the  ufual  return  of  her  menfes,  it  has  gener- 
ally been  imagined,  that  molt  of  her  diforders,  and 

the 


58  DIRECTIONS  FOR  THE 

the  danger  of  mifcarriage,  arife  principally  from  a 
plethora,  and  bleeding  has  almoft  conftantly  been 
prefcribed.  This  mode  of  practice  may  be  good  in 
fome  cafes,  but  it  ought  by  no  means  to  be  adopted 
as  a  general  rule,  when  we  confider  the  cuftoms  of 
the  prefent  times.  In  the  days  of  Queen  Eliza- 
beth, when  our  anceflors  breakfafted  upon  more 
fubftantial  food,  and  lived  a  more  active  life  than 
we  do  at  prefent,  inflammations,  and  all  thofe  dif- 
eafes  which  are  incident  to  plethoric  habits,  were 
extremely  common  in  this  ifland.  With  a  change 
of  diet,  and  mode  of  living,  it  is  well  known  we 
have  experienced  a  change  too  of  thofe  difeafes  for 
fuch  as  are  the  conftant  attendants  of  relaxed  and 
weak  fibres. 

There  are  few  diforders  of  either  fex  which  now 
require  fuch  copious  bleedings  as  they  did  half  a 
century  ago ;  for  in  lefs  than  that  time  a  confidera- 

ble  alteration  has  taken  place  amongfl  us. 
i 

It  is  not  probable  that  the  catameniaare  caufed  by 
a  general  plethora  ;  but  even  if  this  were  allowed, 
it  would  not  from  thence  follow  that  it  is  the  cer- 
tain attendant  of  the  pregnant  ftate%  For  if  we 
confider  the  large  quantity  of  blood  which  muft 
neceffarily  go  towards  the  fupportof  the  child,  and 
the  naufea,  vomiting,  and  almoft  total  lofs  of  appe- 
tite, which  are  the  frequent  concomitants  of  preg- 
nancy 


PREGNANT    STATE.  59 

nancy  in  its  early  ftate,  it  will  appear  that  if  a  pleth- 
ora did  at  the  very  firft  exift,  it  muft  in  many 
conftitutions  have  a  very  fhort  duration.  I  have 
known  feveral  ladies  of  delicate,  tender,  weak  con- 
ftitutions, with  bad  appetites,  who  never  went  to 
their  full  times  when  they  were  bled  during  pregnan- 
cy, and  as  conftantly  became  the  mothers  of  heal- 
thy children  when  that  operation  was  omitted  ;  fo 
that  the  maxim  of  *  Hippocrates,  that  venaefe&ion 
in  a  pregnant  woman  will  produce  a  miscarriage,  efpe- 
cially  ifjhe  be  far  gone,  although  by  much  too  gen- 
eral, appears  to  be  not  fo  ill  founded  as  has  been 
lately  fuppofed  ;  efpecially  if  we  confider  the  re- 
laxed conftitutions  in  the  warm  climate  where  he 

lived  t. 

I 

*  "  Mulieri  uterum  gerenti  vena  fe&a  abortionem  facit,  idque  potifliraum  fi 

foetus  grandior  fuerit." 

Hipp.  Aph.  31.  feft.  5. 

f  Dr,  Lobb,  in  treating  of  the  danger  of  abortion^  has  fonie  ufeful  and  in- 
genious obfervations  on  this  fubjeft.  He  computes  the  monthly  difchargc 
of  women  at  Jive,  fix,  or  feven  ounces  at  a  medium.  Suppofing  it  feven,  the 
total  quantity  in  ten  lunar  months  amounts  tojeventy  ounces,  or  four  pounds, fix 
ounces.  But  the  weight  of  a  child  with  its  placenta  and  membranes,  is  great- 
ly fuperior  to  this  ;  for  in  an  inftance  which  he  adduces,  that  of  the  child 
•wasjix'een  pounds  feven  ounces,  and  that  of  the  placenta,  one  poun  dfour  ounces. 
As  all  this  quantity  of  matter  muft  firft  have  exifted  in  the  mother's  arterial 
fyftem,  he  concludes,  that  during  pregnancy  there  mu{l  be  a  continual  dimi- 
nution of  the  quantity  of  blood,  and  inftead  of  danger  from  a  plethora,  that 
a  women  will  never  be  in  fo  much  want  of  blood  in  any  period  of  her  life. 
This  appears  alfo  from  the  thinnefs  of  the  face  and  body  during  that  period. 
Hence  he  infers  the  danger  from  bleeding  of  caufmg  an  abortion,  by  diminifh- 
jng  the  vital  ftrength  of  the  mother,  and  depriving  the  child  of  its  due  nour- 
jflunent.  He  obferves  from  faft,  that  young  women  who  have  their  full 

quantity 


60  DIRECTIONS    FOR  THE 

I  have  experienced  the  happy  effe&s  of  giving 
afles  milk,  Pyrmont,  and  Seltzer  waters,  bark,  and 
not  only  the  dulcified,  but  the  acid  vitriolic  elixir. 
I  have  known  fhort  rides  on  horfeback,  repeated 
daily,  procure  fuccefs  when  total  confinement  would 
not  ;  and  have  for  a  great  number  of  years  been 
fenfible  of  the  good  effeds  of  cold  bathing*,  not 
only  in  preventing  mifcarriages,  when  every  other 
method  has  been  likely  to  fail,  but  other  diforders 
which  are  incident  to  pregnant  women,  and  gener- 
ally 

quantity  of  blood,  their  flefh  firm,  their  bodies  ftrong  and  agile,  and  inured  to 
exercife,  fcarcely  ever  fuffer  abortion,  except  from  fome  violent  occafion  ; 
whereas  they  are  ntoft  fubjeft  to  mifcarry  who  are  of  a  tender  conilitution, 
have  lax  mufcles,  a  feeble  pulfe,  and  too  little  blood. 

Compend.  of  the  Praftice  of  Phyfick,  p.  89,  &  feq, 

*  1  have  not  only  obferved  v  the  good  effe&s  of  cold  bathing  in  pregnant 
women,  but  have  for  fome  few  years  paft  recommended  it  to  nurfes  giving 
fuck,  who  have  reaped  great  advantages  from  it.  What  firft  put  me  upon 
this  practice  was  the  information  I  had  gained  that  feveral  of  the  women  at 
Scarborough,  who  made  it  their  bufinefs  to  attend  upon  ladies  during  their 
being  in  the  fea,  found  that  when  they  were  nurfes  they  had  better  health, 
were  much  ftronger,  and  had  greater  plenty  of  milk  than  they  had  at  other 
times  before  they  began  this  pradice» 

There  is  a  contrivance  for  bathing  in  the  patient's  clofet,  which  I  am  in- 
formed has  been  pracYifed  many  years  in  Scotland,  and  which  is  really  very 
commodious.  The  machine  that  contains  the  water  is  made  of  tin,  and  is 
fafpcnded  over  the  patient's  head,  who  ftands  in  an  empty  tub,  furrounded 
by  blankets,  which  are  fixed  to  the  machine  ;  every  thing  being  thus  prepar- 
ed, the  patient  pulls  at  a.  cord,  and  the  water  falb  upon  her  through  a  cul- 
lender. 


Dr.  Lind  fays,    <:  The  ufc  of  the  cold  bath,  cither  in  a  tub,  or  to  dip 
the  lea  early  in  the  morning,    has  been  found  extremely  beneficial  in  wa: 

weather, 


PREGNANT    STATE.  $t 

ally  attendant  upon  a  weak  lax  fibre.  By  cold 
bathing  I  do  not  mean  the  making  ufe  of  a  bath, 
cold  to  the  greateft  extreme,  but  the  ufe  of  fuch  as 
that  at  Buxton,  or  at  Matlock,  of  fea  bathing,  or 
bathing  in  a  tub  in  the  patient's  own  houfe,  with 
the  water  a  little  warmed.  I  have  frequently  ad- 
vifed  my  patients  to  bathe  every  other  day  at  a 
time  when  the  ftomach  is  not  overloaded,  and  not 
to  ilay  at  all  in  the  water  ;  to  begin  this  procefs  as 
early  as  poflible,  even  before  they  have  conceived, 
as  there  will  then  be  no  danger  from  the  furprife, 
and  to  continue  it  during  the  whole  term  of  preg- 
nancy ;  and  feveral  have  bathed  till  within  a  few 
days  of  their  delivery.  From  the  fuccefs  I  have 
feen  attend  this  practice  in  preventing  mifcarriages, 
and  many  of  the  diforders  peculiar  to  the  pregnant 
flate,  particularly  naufea  and  vomiting,  I  am  fatif- 
fied  itley  are  much  feldomer  to  be  attributed  to  a 
plethora  than  to  weak  lax  fibres,  and  a  fympathet- 

ic 

•weather,  and  in  hot  countries  ;  and  that  he  can  affirm,  from  his  own  experi- 
ence in  hot  climates,  that  many  diarrhoeas  and  other  complaints,  the  pure  and 
fole  effecl:  of  an  unuiual  and  great  heat  (relaxing  the  fyftem  of  the  folids,  and  oc- 
cafioning  a  colliquation  of  the  animal  juices)  have  not  only  been  cured  by 
cold  bathing,  but  their  return  and  the  attack  of  fuch  difeafes  effectually  pre- 
vented by  it." 

On  the  Health  of  Seamen,  p,  44. 

Dr.  Whytt,  fpeaking  of  cold  bathing,  fays,  ««  I  (hall  only  obferve,  that  I 
have  known  it  of  great  fervice  to  feveral  women,  who  chiefly  from  a  weak-* 
ncfs  of  their  nervous  fyftem  were  liable  to  abortions," 

Seelikewife  Sir  John  Floyer  and  Dr,  Barnard  on  Cold  Batbi»g' 


62  DIRECTIONS    FOR  THE 

£c  afFe&ion  of  the  nerves  from  a  diftention  of  the 
uterus  :  And  in  thefe  cafes  I  have  generally  found 
that  exercife,  bark,  elixir  of  vitriol,  and  Pyrmont 
water,  joined  with  cold  bathing,  have  had  the  befl 
effeft. 

I  am  convinced  that  bleeding  is  too  indifcrimin- 
ately  ufed,  and  too  often  repeated ;  and  that  though 
it  may  on  fome  occafions  give  immediate  relief,  yet 
upon  the  whole  it  muft  aggravate  the  complaints, 
weaken  the  patients,  and  render  them  more  liable 
to  putrid  difeafes .  But  I  would  not  be  underftood  to 
mean  that  bleeding  is  never  necefTary :  in  fome  habits 
and  in  inflammatory  diforders.  it  certainly  is  fo,  par- 
ticularly if  the  patient  complain  of  a  fenfe  of  fulnefs, 
pain  of  the  head  and  back,  with  a  flrong  full  pulfe, 
&c.  and  has  had  a  better  appetite  and  ufed  lefs  exer- 
cife than  before  her  pregnancy ;  but  even  in  plethoric 
cafes  unattended  with  inflammatory  fymptoms,  aff- 
es  milk,  Seltzer  water,  elixir  of  vitriol,  and  an  ac- 
tive life,  anfwer  the  fame  purpofe  as  bleeding  ; 
with  this  advantage,  that  they  will  obviate  the  pref- 
ent  plethora  without  favouring  its  return,  which  is 
a  flrong  objection  to  frequent  bleeding  ;  at  the 
fame  time  that  they  ftrengthen  and  brace  thefolids. 

Riding  on  horfeback,  and  indeed  all  kind  of  ex- 
ercife, muft  be  Avoided,  when  any  fymptoms  of 
abortion  appear  ;  on  that  occafion,  total  reft  and  a 
recumbent  poflure  are  undoubtedly  of  the  greateft 

confequence. 


PREGNANT     STATE.  63 

confequence.     Nor  is  much  exercife  proper  at  the 
latter  end  of  pregnancy. 

The  keeping  the  inteftinal  canal  open  is  an  ar- 
ticle of  great  importance  ;  for  this  purpofe  vegeta- 
bles and  ripe  fruit  in  large  quantities  may  be  al- 
lowed, bitter  antifeptic  purges  in  fmall  dofes  fhould 
be  given  every,  or  every  other  night,  and  even  aloet- 
ics  (if  the  patient  be  not  fubjecl;  to  the  piles)  mixed 
with  other  antifeptic  refmous  gums.  The  ufe  of 
thefe  will  prevent  the  inteftines  from  being  plug- 
ged up  by  accumulations  of  hardened  faeces,  where- 
by putrid  flatulencies  are  generated.  Gentle  vom- 
its may  be  adminiflered  with  fafety  and  advantage, 
in  order  to  cleanfe  the  ftomach  when  neceffary, 
and  teas  made  of  bitter  antifeptic  herbs  may  be 
drank  daily  :  vegetable  acids,  columbo  *,  and  like- 

wife 

*  Though  the  columbo  root  has  not  yet  made  its  way  into  any  of  the  difpen- 
fatories,  nor  been  mentioned  by  any  author  we  are  acquainted  with,  yet  it  has 
been  given  in  England- thefe  thirty  years  or  more,  in  obftinate  vomitings,  and 
in  many  other  complaints  of  the  ftomach  and  bowels.  It  was  firft  brought 
to  Manchefter  by  a  worthy  Apothecary,  about  five  and  twenty  years  ago,  and 
has  been  conftantly  given  ever  fmce  in  bilious  diforders  of  both  fexes  :  he 
had  it  from  Mr.  Robinfon  of  Richmond,  a  gentleman  with  whom  he  lived, 
who  had  given  it  for  feveral  years  for  fuch  like  complaints.  Mr.  Robinfon 
brought  it  from  the  Eaft  Indies,  and  faid  the  natives  there  frequently  took 
about  as  much  of  the  powder  as  would  lie  upon  a  fixpence  in  a  glafs  of  ar- 
rack, for  the  difeafes  I  have  mentioned,  and  it  was  generally  attended  with 
fuccefs. 

Dr.  Percival,  whofe  merit  as  an  author  is  fufficiently  known  to  the  medi- 
cal world,  has  been  fo  obliging  as  to  favour  me  with  fomeufeful  experiments 
he  has  lately  made  upon  this  valuable  drug,  rod  which  he  intends  in  a  fhort 


64  DIRECTIONS  FOR  THE 

wife  neutral  mixtures,  taken  during  the  aft  of  ef~ 
fervefcence,  which  are  all  antiputrefcents,  operate 
to  the  fame  end,  and  are  generally  of  great  fervice 
jn  vomitings  occaiioned  by  a  redundancy  of  acrid 
putrid  bile.  Raw  eggsf  taken  at  any  time  during 

pregnancy, 

time  to  publifh.  The  refult  of  thefc  experiments  are,  that  columbo  root  is 
inferior  as  an  antifeptic  to  the  Peruvian  Bark,  in  preferving  animal  flefh,  but 
fuperior  both  to  the  bark,  and  to  camomile  flowers,  in  preferving  bile 
from  putrefaction,  and  in  reftoring  it  when  putrefied.  Thai  an  infufion  of 
trie  bark,  when  mixed  with  putrid  gall  and  faliva,  inftantly  produced  a  coagu- 
lation of  the  gall,  and  confiderably  increafed  the  fcetor  of  it  ;  whereas  an  in- 
fifion  of  columbo  united  perfectly  with  it,  and  very  powerfully  corrected  its 
offenlive  fmell.  Thefe  experiments,  I  think,  explain  to  us  the  mode  of  its 
a£Hon,  and  the  reafon  of  its  fuccefs  in  bilious  vomitings,  awd  many  other  af- 
feclions  in  the  ftomach  and  bowels,  and  point  out  to  us  what  diforders  it  is 
likely  to  relieve  and  cure.  Hence  the  Doftor  very  juftly  infers  that  the  util- 
ity of  the  columbo  root  mutt  be  evident  in  difeafes  of  a  putrid  tendency,  or 
man  impaired  digeftion  from  vitiated  bile  or  corrupted  faliva. 

r  It  is  not  improbable  that  the  temporary  jaundice,  to  which  women  with 
child,  new  born  infants,  and  even  adults  of  both  fexes,  are  frequently  fubjeft, 
owes  its  origin  to  the  ftoppage  of  the  mouth  of  the  duftus  commuriis  chole- 
clocaus,  by  fome  tenaceous  gluten  obftrufting,  either  totally  or  in  part,  the 
paiTage  of  the  bile  into  the  duodenum,  and  thereby  occafioning  its  return  in- 
to the  blood.  The  attention  I  have  paid  to  jaundiced  patients  of  both  fexes, 
and  of  every  age,  who  have  been  cured  by  frequently  taking  raw  eggs  in  cold 
fpring  water,  has  inclined  me  much  to  this  opinion.  My  fuppofition  is,  that 
eggs  a£t  as  a  diffolvent  of  the  gluten  which  obftru&s  the  mouth  of  the  duftj 
thereby  opening  a  free  paffage  for  the  bile  into  the  duodenum.  We  know 
that  yolks  of  eggs  will  deflroy  the  tenacity  of  the  gums  and  refms,  and  ren- 
der not  only  them,  but  alfo  oils  and  natural  balfams,  mifcible  with  water* 

The  firft  trial  I  had  of  this  remedy  was  upon  myfelf,  about  fourteen  years 
ago,  -when  I  had  been  affiifted  with  the  jaundice  many  weeks,  and  was  much 
reduced,  no  bile  having  fora  long  time  paftinto  the  inteftines,  when  my  Ikin 
•was  aimed  black,  and  after  I  hsd  in  vain  taken  large  quantities  of  foap, 
madder,  flcol,  rhubarb,  and  aloetic  medicines.  An  officer  of  marines  told 

me 


PREGNANT    STATE.  65 

pregnancy,  but  efpecially  at  the  latter  end  of  it,  are 
very  ferviceable,  (provided  the  flomach  will  bear 
them.)  in  preventing  and  curing  that  temporary 
jaundice  tp  which  fome  women  are  liable.  If  the 

patient 

me  that  if  he  might  be  allowed  to  prefcribe,  he  would  immediately  cure  me, 
I  laughed  at  hi*  propofal ;  when  he  informed  me,  that  fome  years  before, 
in  the  Mediterranean,  he  was  troubled  -with  the  fame  diforder  to  as  great  a 
degree  as  myfelf,  and  that  afier  he  had  ineffectually  tried  all  the  remedies  the 
Surgeon  of  the  fhip  could  think  of,  a  Spanifh  Phyfician  at  Minorca  tad  affur- 
cd  him  he  could  c«xe  him  in  a  few  days,  by  this  fimple  prefcription  only — 
two  raw  eggs,  the  whites  as  well  as  yolks,  to  be  taken  every  morning  in 
a  glafs  of  water  fafting,  with  the  addition  of  an  egg  every  four  hours  during 
the  day.  That  in  three  days  after  following  this  advice  he  began  to  perceive 
the  bile  in  his  flools,  though  none  had  appeared  in  them  for  many  weeks  be- 
fore ;  that  he  immediately  began  to  recover,  and  was  very  foon  cffe&ually 
cured.  Upon  confidering  the  diffolvent  property  of  yolks  of  eggs,  and  that 
eggs  muftat  lead  afford  a  nourifhment  totally  void  of  acrimony,  I  began  to 
entertain  a  more  favourable  opinion  of  the  recipe, 

I  tried  it  and  found  it  had  exactly  the  fame  effect  which  he  prornifed  me. 
Though  I  was  certain  no  bile  had  paffed  through  me  for  fix  weeks  before^ 
upon  taking  the  eggs  only  three  days  it  began  to  flow,  and  in  only  one  day 
more  in  as  great  plenty  as  I  could  wifh,  I  continued,  however,  to  take  them 
feveral  months,  and  have  never  fmce  had  any  return  of  the  diforder. 

I  have  recommended  the  ufe  of  them  to  many  perfons  under  the  fame  com- 
plaint, and  have  always  had  the  fatistaftion  of  finding  their  fuccefs,  except  in 
cafes  where  the  diforder  was  occafioqed  by  a  difeafed  liver,  or  by  ftones  io 
the  gall  bladder. 

^_ 
Js  pot  the  following  cafe  and  diffeftton  from  Sir  John  Pringlc  fome  proof 

of  what  I  have  advanced  ?  "  A  gentleman  of  thirty  fix  years  of  age,  who  di- 
ed of  a  dropfy  following  an  obflinatc  jaundice,  was  opened  about  twenty  four 
hours  after  his  death.  The  liver,  by  its  tendernefs,  feemed  to  be  in  a  cor- 
rupted fiate.  The  gall  bladder  was  full  of  bile,  and  three  times  larger  than 
is  common.  The  duftis  communis  was  fo  clok\yjlopp$d  at  its  entry  into  the 
4ft$;num  that  no  bile  could  be  fqueezed  out  of  the  bladder  into  that  gut.'* 
Appendix  to  the  Dif,  of  the  Array,  M-& 

E 


661  DIRECTIONS  FOR  THE 

patient  cannot  take  raw  eggs,  or  the  diforder  (houldj 
prove  very  obftinate,  a  fmall  dofe  of  calomel  may- 
be given  with  fafety  and  advantage. 

Lacing,  the  flays  tight  has  been  pra&ifed  not 
merely  in  conformity  to  the  rules  of  fafhion,  but 
from  a  miftaken  notion  that  by  prefling  the  chil- 
dren lower  down,  the  mothers  would  have  better 
times.  This  I  will  venture  to  fay  is  one  of  thofe 
vulgar  errors  which  have  not  the  leaft  foundation 
in  either  fa 61  or  reafon.  I  never  yet  knew  chil- 
dren lie  too  high.  In  their  natural  fituations  they 
are  much  lefs  inconvenient  to  their  mothers,  and 
are  carried  with  greater  eafe ;  to  which  I  muft  add, 
that  the  mothers  have  at  leaft  as  good  or  better 
limes  than  when  they  are  pre fifed  down  too  low, 
by  which  means  the  belly  of  the  mother  becomes 
pendulous,  and  the  child  is  troublefome  to  carry  ; 
the  inconvenience  increafes  too  with  every  child, 
and  where  the  mother  has  had  a  great  number,  the 
weight  at  laft  becomes  intolerable.  The  conftant 
prefTure  of  the  uterus  upon  the  bladder  in  this  cafe 
occafions  frequent  motions  to  make  water  ;  an  in- 
continence or  involuntary  difcharge  of  itfometimes 
comes  on,  and  it  is  attended  with  many  other  in-. 
conveniences. 

I  would  advife  every  pregnant  woman  to  wear 
jumps  buckled  on  very  flack,  having  broad  eafy 

{boulder 


PREGNANT    STATE.  $7 

fhoulder  ftraps,  with  tapes  fewed  to  the  bottom  of 
die  jumps,  to  which  the  petticoats  and  pockets  may 
fae  fattened  ;  fo  that  there  may  be  neither  tightnefs 
round,  nor  weight  upon  the  belly,  but  when  the 
woman  is  in  an  upright  pofition,  as  much  of  the 
weight  of  what  flie  externally  carries  as  poflible, 
may  hang  from  her  (boulders. 

This  will  preferve  the  womb  from  being  prettied 
too  ftrongly  againfl  the  lower  inteftines,  and  will 
help  to  prevent  that  coftivenefs,  and  that  inconti- 
nence of  urine  which  are  too  often  attendant  upon 
the  pregnant  date.  But  when  the  belly  is  remark- 
ably pendulous,  preuing  too  much  upon  the  pubes, 
fo  as  to  occafion  thefe  troublefome  fymptoms,  in 
order  to  counterbalance  this  preffure,  a  bandage 
may  be  worn  under  the  fhift,  its  lower  edge  com- 
ing to  the  pubcs  before,  and  fupported  on  the  fides 
i)y  the  hips,  or  fpine  of  the  ilia.  The  upper  edge 
ihould  furround  the  Abdomen  above  the  point  of 
its  greateft  diameter,  to  prevent  its  flipping  down, 
cmlefs  the  hips  mould  prove  a  fufficient  fupport. 
This  bandage,  or  kind  of  under  waiflcoat,  fhould 
be  drawn  tight,  with  a  lace  behind,  according  as 
circumliances  require,  and  fhould  likewife  be  fup- 
ported by  ftraps  paffing  over  the  fhoulders. 

In  the  latter  months  of  pregnancy,   the  frequent 
lying  down  upon  a  couch  or  bed  in  the  day   time 
will  give  great  relief  to  the  mufcles,  by  taking  of? 
E  2  the 


68  DIRECTIONS,    &c. 

the  incumbent  weight,  and  thereby  preventing  thoffc 
pains  of  the  belly,  back,  hips,  and  thighs,  and  thofe 
fwellings  of  the  legs  which  are  fo  ufual  at  that  pe- 
riod. 

The  directions  I  have  attempted  to  lay  down  in 
this  chapter  will  admit  of  many  variations  accord- 
ing to  particular  circumftances ;  but,  in  general,  I 
can  fpeak  with  confidence  of  the  advantages  refult- 
ing  frcm  them  ;  and  fo  far  from  containing  any 
thing  that  can  weaken  or  injure  the  conftitution,  I 
have  no  doubt  that  the  obfervance  of  them  will 
greatly  tend  to  eftablifh  the  general  health  of  th,e 
patients. 


CHAP, 


^^^^^ 


C  H  A  P.      V, 


OF  NATURAL  BIRTHS,  PARTICULARLY  OF  tan* 
SECUNDINES,  AND  THE  PREVENTION  OF 
TERPA1NS. 


HE  retention  of  the  fecundmes 
in  almoft  all  ages,  engaged  the  atten-< 
tioh  of  the  profeffors  of  the  obftetrib 
art.  Controverfies  and  difputes  have 
arifen,  and  different  modes  of  prac-* 
tice  have  been  purfued,  yet  the  proper  treatment? 
has  not  hitherto  been  precifely  determined.  There 
are  fome  who  contend  for  the  manual  extra'&ibri, 
immediately  after  the  birth  of  the  child,  in  all  cafes 
indiscriminately.  There  are  others  who  leave  the 
bulinefs  entirely  to  nature,  in  every  eafe  whatfdev- 
er  ;  and  there  is  yet  a  third  clafs,  who  purfuihg  a 
middle  cburle,  try  gentle  methods  for  a  while,  and, 
upon  the  failure  of  thefe,  proceed  to  manual  etf« 
E  3 


70  OF  NATURAL  BIRTHS. 

tra&ion.     Advantages  and  difadvantages  are  faid 
to  attend  thefe  various  modes  of  pra6Hce. 

The  firft  of  thefe  has  now  the  feweft  advocates,, 
for  certain  pain  £ nd  danger  rnufl  attend  the  opera- 
tion,  and  in  almoft  every  cafe,  the  odds  are  great 
that  it  is  totally  unneceffary.  The  fecond  is  fup- 
ported  by  profeffbrs  of  great  abilities  and  experi- 
ence ;  but  the  fecundines  fometimes  acquiring  a 
great  degree  of  putridity,  by  retenfion  for  many 
days  in  the  uterus,  or  not  coming  away  at  all,  but 
occafioning  putrid  fevers,  and  fometimes  floodings 
fo  violent  as  to  bring  on  the  patient's  death,  thefe 
reafons,  added  to  the  general  difcontent  arifmg 
from  the  retention,  not  only  to  the  patient,  but  her 
friends,  have  very  juftly  prevented  this  mode  from 
being  generally  adopted. 

The  disadvantage  faid  to  attend  the  lail  method 
is  this  ;  by  waiting  an  hour  or  two,  you  lofe  the 
opportunity  of  extracting  the  fecundines,  the  womb 
conrrading,  either  at  its  mouth,  or  acrofs,  its  mid- 
dle, like  an  hour  glafs,  by  which  contraction,  lac- 
eration is  endangered,  if  the  hand  be  forced  into 
the  uterus-. 

The  bringing  the  art  of  midwifery  to  perfection, 
upon  fcientific  and  mechanical  principles,  leems  to 
have  been  refer ved  for  the  prefent  generation.  We 

have 


OF    NATURAL    BIRTHS.  71 

have  been  but  lately  able  to  explore  the  fecret  ope- 
rations of  nature.  The  ancients,  and  even  the 
moderns,  till  within  a  few  years  paft,  were  not  on- 
ly entirely  ignorant  of  the  pofition  of  the  child  in 
natural  labours,  but  even  during  the  whole  time  of 
pregnancy  :  they  had  not  properly  confidered  the 
exacl  form  and  dimenfions  of  the  pelvis*,  and  the 
effect  thefe  mufl  neceffarily  have  upon  the  infant's 
head,  during  the  time  of  its  delivery. 

Sir 

'*  *  On  the  whole,  it  is  of  the  utmoft.  confequence  to  khow,  that  the  brini 
of  the  pelvis  is  wider  from  fide  to  fide,  than  from  the  back  to  the  forepart^ 
but  that  at  the  under  part  of  the  bafori,  the  dimenfions  are  thereverfe  of  tkis 
proportion,  and  that  the  back  part  in  point  of  depth,  is  to  the  forepart  a3 
three  to  one,  and  to  the  fides  as  three  to  two." 

Smellie's  Midwifery,  vol.  i.  p.  8iv' 

**  In  this  Table,  befides  the  gerteraJ  ftrufture  and  figure  of  the  feveral  bones, 
the  dimenfions  of  the  brim  of  the  pelvis,  and  the  diftance  between  the  undet 
parts  of  the  offa  ifchium,  are  particularly  to  be  attended  to,  from  -which  it 
will  appear,  that  the  cavity  at  the  brim  is  commonly  wider  from  fide  to  fide 
than  from  the  back  to  the  forepart,  but  that  the  fides  below  are  in  the  contra- 
ry proportion.  The  reader,  however,  ought  not  from  this  to  conclude; 
that  every  pelvis  is  fimilar  in  figure  and  dimenfions,  fince  even  well  formed 
ones  differ  in  fome  degree  from  each  other.  In  general,  the  brim  of  the 
pelvis  meafures  about  five  inches  and  a  quarter  from  fide  to  fide,  and  four 
inches  and  a  quarter  from  the  back  to'  the  forepart,  there  being  likewife  the 
fame  diftance  between  the  inferior  part  of  the  offa  ifchium.  AH  thefe  meaf- 
ures, however,  muft  be  underftood  as  taken  from  the  fkeleton  ;  for  in  the 
fubjeft,  the  cavity  of  the  pelvis  is  confiderably  diminifhed  by  its  teguments 
and  contents.  Correfpondent  alfo  to  this  diminution,  the  ufual  dimenfions 
of  the  head  of  tke  full  grown  fcetus  arc  but  three  inches  and  a  half  from  eat 
to  ear,  and  four  inches  and  a  quarter  from  the  forehead  to  the  hind  head.'* 
Smellie's  Explanat,  ef  his  firft  Anatomical  Table, 


72        'Or  NATURAL    BIRTHS. 

Sir  Fielding  Ould*,ina  Treatife  upon  Midwife* 
ry,  publilhed  at  Dublin  in  1742,  was  the  firft  who 
feems  to  have  difcovered  that  the  fituation  of  the 
child  in  the  beginning  of  labour  is  not  with  its  fore- 
head towards  the  mother's  back,  but  turned  to  one 
fide.  But  though  he  was  the  firft  that  gave  the 
hint,  he  had  not  then  fo  thoroughly  confidered  it 
as  fome  others  have  done  fince  the  publication  of  his 
Treatife. 

Dodor  Smellie  publifhed  his  firfl  volume  of  Mid- 
wifery in  1752,  and  his  Anatomical  t  Tables  in 
1754,  wherein  he  has  more  fully  explained  this 
matter. 

We  are  obliged  to  Dr.  Johnfon,  whofe  General 
Syftem  of  Midwifery  was  publifhed  in  1769,  for 
the  confirmation,  and  farther  illuftration  of  the 
manner  in  which  the  child's  head  paffes  through 
the  pelvis. 

I  muft  here  take  notice  of  an  error  in  practice, 
which  has  not,  that  I  know,  been  remarked  by  any 

writer 

*  Treatife  of  Midwifery,  p,  2?. 

t  Notwithftandirrg  it  lias  been  handed  down  as  an  invariable  truth,  from 
the  earhett  accounts  of  the  art,  to  the  prefent  times,  that  when  the  head  of 
the  foetus  preferred,  the  face  was  turned  to-  the  pofterior  pan  of  the  pelvis, 
yet  from  Mr.  Quid's  obfervation,  as  well  a-s  from  fome  late  difleclions  of  the 
gravid  uterus,  and  what  I  myfelf  have  obferved  in  praSice,  I  am  led  to  be- 
lieve that  the  head  prefents,  for  the  moft  part,  as  is  here  delineated,  withoae 
ear  to  the  pubes,  and  the  other  to  the  os  facrum  ;  though  fometimes  this 
Baay  vary,  according  to  the  term  of  the  head,  as  well  as  that  of  the  pelvis*'* 
Sraellie's  Explanat,  of  his  gth  Anat.  Table, 


OF  NATURAL  BIRTHS.  73 

writer  on  this  fubjeft  :  It  depends  upon  the  fol- 
lowing principles  : 

Thefe  great  improvers  of  the  art,  confidering  la- 
bour as  a  mechanical  operation,  have  perceived  that 
the  head  in  its  pafTage  through  the  pelvis  muil  al- 
ter its  direction,  according  to  the  width  of  it  in  dif- 
ferent places  :  but  here  they  flop  fhort.  They 
have  not  applied  this  rule  to  the  moulders,  which, 
though  not  forming  fo  great  an  obflacle  as  the 
head,  are  yet  certainly  capable,  by  their  bulk*,  of 

forming 

"  *  A  middle  fized  woman  brought  forth  by  the  natural  efforts  a  large 
fized  child,  whofe  weight  and  dimenfions  were  as  follow  :  The  weight  ten 
pounds  and  eight  ounces  troy.  The  diameter  of  the  he«d  from  temple  to 
temple  was  three  inches  and  an  half,  from  the  os  frontis  to  the  occiput  four 
inches  and  an  half,  and  the  circumference  at  thofe  parts  was  thirteen  inches, 

"  The  breadth  of  the  body  at  the  fhoulders  was  five  inches,  the  length  of 
the  head  from  vertex  to  chin  fix  inches,  and  that  of  the  whole  child  full 
twenty  one  inches. 

««  A  young  woman  who  was  mufcular,  fmall  fized,  and  in  her  pregnancy 
had  futtained  a  very  tedious  and  violent  labour,  at  laft,  by  force  of  pains 
brought  forth  a  child,  whofe  weight  was  only  eight  pounds  five  ounces  troy; 
its  head  however  was  of  the  following  dimenfions  :  From  temple  to  tempJe 
four  inches,  from  os  frontis  to  occiput  five  inches  and  an  half,  the  circumfer- 
ence at  thofe  parts  fourteen  inches ;  and  the  length,  from  vertex  to  chin,  was 
eight  inches  and  an  half. 

"  This  child's  head  was  greatly  fqueezed  out  in  length,  by  the  violent 
compreffure  which  it  had  fuffered  in  its  courfe  through  the  pelvis. 

"  A  large  woman  who  had  borne  feveral  children,  in  1759  brought  forth 
a  child  of  the  following  weight  and  dimenfions  :  The  weight  fourteen  pounds 
and  one  ounce  troy,  the  length  of  the  whole  body  twenty  two  inches  and  aa 

half. 

«  The 


74         Of  NATURAL    BIRTHS. 

forming  a  refinance  when  offered  in  a  wrong  poft- 
tion.  Now  the  greateft  breadth  of  the  head  being 
in  a  line  which  forms  a  right  angle  with  one  which 
paffes  through  the  fhoulders,  it  neceiTarily  follows, 
that  all  the  turns  made  by  the  fhoulders  mud  be 
oppofite  to  thofe  of  the  head.  When  the  head 
pafles  with  the  face  towards  the  facram,,and  the 
hind  part  of  the  pubes,  the  moulders  mud  pafs 
fideways  ;  and  vice  verfa.  Accordingly  we  find 
that  this  is  the  way  in  which  nature  herfelf  pro- 
ceeds, though  art  has  neglected  to  pay  attention  to  it. 

We  are  directed  by  all  writers  in  midwifery  to 
bring  out  the  fhoulders  as  foon  as  the  head  is  pro- 
duced,  by  taking  hold  of  the  head  and  pulling  it 
forward  in  the  fame  direction  ;  whereas  when  the 
natural  pains  are  allowed  to  accomplifh  the  work, 
they  always  come  out  with  a  turn,  which  throws 
the  broad  part  of  the  fhoulders  into  the  fame  direc- 
tion in  which  the  largeft  diameter  of  the  head  had 
lately  been,  th'at  is,  one  moulder  to  the  facrurn  and 
the  other  to  the  pubes,  or  nearly  fo.  By  this  im- 
proper 

u  The  diameter  of  the  head  froiri  temple  to  temple  four  inches  ;  from  os- 
frontis  to  occiput  five  inches  and  one  eighth;  its  circumference  at  thofe 
parts,  fifteen  inches  ;  and  its  length  from  vertex  to  chin  five  inches  and  on6 
fourth. 

"  The  circumference  of  the  body  at  the  Chouiders,  arms  included,  eighteen 
inches  and  an  half  ;  and  a  the  ilia  fifteen  and  an  half.  The  breadth  of  the 
body  at  the  fhoulders,  fcven  Inches,  and  at  the  ilia  fix  inches." 

Johnfon's  Midwifery,  p,  isy 


OF  NATURAL   BIRTHS.          j5 

proper  interference  of  the  artift,  violence  is  offered 
to  the  vagina.  The  womb  and  its  ligaments  fufFer  by 
an  undue  diftenfion,  and  thus,  I  have  reafon  to  be- 
lieve, inflammations,  prolapfufes,  retentions  of  u- 
rine,  and  a  train  of  difagreeable  fymptoms  are  often 
caufed.  This  improper  and  too  hafty  delivery  of 
the  moulders,  in  natural  labours  often  occafions 
the  retention  of  the  fecundines,  and  is  in  fome 
meafure  the  caufe  of  afterpains  ;  for  the  womb  be- 
ing improperly  ftretched  out,  and  the  body  of  the 
child  prematurely  delivered  without  a  natural  pain, 
the  womb,  inftead  of  contracting  regularly  from 
its  fundus,  is  thrown  into  fpafmodic  ftri6hires,  ei- 
ther at  its  mouth,  or  acrofs  its  middle.  By  this, 
means  the  fecundines  are  retained  tilLthefe  unnatur- 
al contractions  are  overcome  ;  and  the  mouths  of 
the  finufes  or  uterine  veins  are  clofed  before  they 
could  have  an  opportunity  of  gradually  contract- 
ing and  of  difcharging  themfelves  of  the  blood 
which  they  contain,  the  ferous  part  of  which  drains 
away  and  leaves  the  crafTamentum  behind  in  the 
finufes,  which  grows  the  more  fibrous  the  longer 
it  remains  ;  and  the  parts  being  irritated  by  this 
extraneous  body,  endeavour  to  difburden  them- 
felves, by  what  are  called  afterpains*. 

Before 

*  Dr.  Burton  aclvifes  a  method  of  preventing  afterpains  being  very  troub- 
lefome,  which  I  doubt  not  would  be  effectual,  but  at  the  fame  time  fo  pain- 
ful and  fo  unnatural,  that  I  apprehend  it  cannot  be  praftifed  with  any  degree 
of  propriety.  The  plan  I  have  laid  down  will  be  as  effectual  without  being 
liable  to  thefe  objections.  He  fays,  "Where  I  have  been  employed  for  / 

perfons 


76  OF  N  A  T  U,R  A  L  B I R  T  H  S. 

Before  we  attempt  to  give  aid  to  nature,  it  is  our 
du  y  to  watch  her  operations,  and  to  trace  her 
through  all  her  paths  ;  taking  care  at  the  fame  time 
not  to  mi  flake  her  efforts  for  thofe  of  art,  and  to 
remember  that  few  of  the  human  race  in  this  part 
of  the  globe  are  in  a  ftate  of  nature,  for  which  prop- 
er allowances  muft  be  made.  We  (hall  then  be 
better  able  to  aflift  her  when  me  (lands  in  need, 
and  to  fet  her  right  if  by  any  accident  (he  has  been 
diverted  from  her  courfe.  Let  us  confider  the  mofl 
natural  cafe  of  labour  that  can  poflible  happen, 

M 

Should  a  flraight  healthy  young  woman,  who 
had  never  fuffered  from  improper  drefs,  inactivity , 
or  unwholefome  diet,  be  feized  with  labour  pains, 
upon  an  open  common,  totally  unattended,  and 
with  no  affi fiance  near,  me  would  for  feme  time 
walk  about,  then  fit  down  to  reft,  then  rife  and 
walk  again,  till  for  her  own  eafe,  and  the  fafety  of 
the  child,  Hje  would  find  it  neceffary  to  lie  down*. 

During 

per fons  who  always  in  former  tedious  labours  were  afflicted  with  violent  af- 
tcrpains  tor  fome  confiderable  time,  I  have  relieved  them;  for  by  keeping  my 
fift  at  thefundus  uteri,  and  gently  moving  it  in  a  rotatory  motion,  an  incredible 
number  of  thefe  clots  have  come  out  of  the  finufes  in  a  very  little  time,  and  hav- 
ing brought  all  out  of  the  womb,  the  afterpains  have  been  t;  i  fling  afterwards.'* 

Eflay  on  Midwifery,  p.  346- 

*  Dr.  Denman  is  of  opinion,  and  1  think  with  great  probability  of  truth, 
that  refting  on  the  hands  and  knees,  is  the  pofition  inftiri&ively  fought  for,- 
and  perhaps  moft  natural  in  time  of  labour.  Vid.  Introdu&ion  to  the 
Practice  of  Midwifery,  Part  i.  p.  58.  London,  1782, 


OF  NATURAL    BIRTH£.          7T 

During  this  time  the  mouth  of  the  womb  would  be 
gradually  opening,  and  the  dilatation  would  occa- 
lion  a  feparation  of  the  fpongy  chorion  from  the 
womb.     The  communicating  vefTels  breaking,  they 
would  difcharge  a  lymph   moiftenmg  the  vagina 
and  the  external  parts  with  a  mucilaginous  liquor. 
She  would  have  intervals  of  eafe,  and  perhaps  dur- 
ing thefe    intervals  fome   fleep.     The  membranes 
with  their  contained  water  would  advance,  and  ?.t 
laft    burfting,   the  remainder  of  the  water  would 
gradually  drain  away,  and  further  help  to  moiften 
the  parts.      The   womb  would  be  contracting  fey 
degrees   during  every  pain;  the  head  would  ad- 
vance and  make  the  proper  turns  ;  the  perinasum 
would  gradually   ftretch  and  lengthen,   till  a  pain 
had  forced  the  head  into  the  world.     She  would 
then  have  a  little    refpite.       The  pain  ^  returning 
would  drive  the  moulders  forwards,  making  their' 
proper    turns,   and  accommodating  themfelves  to 
the  different  dimenfions  of  the  pelvis,  till  they  were 
quite  excluded.     She  would  then  have  another  ref- 
pite.    The  returning  pain  would  expel  the  hips, 
but  with  lefs  difficulty,  the   womb  continuing  to 
contract  itfelf  regularly  as  the  child  advances,  when 
in  confequence  of  the  pain  the  whole  child  would 
be  delivered.     If  the   navel  firing  fhould  break,  it 
would  not  bleed.     After  a  little  while,  when  {he 
had  fomewhat  recovered  herfelf  from  the  fatigue 
$ie  had  undergone,  and  the  womb  had  ftill  further 

contracted 


j8  O*  NATURAL  BIRTHS. 

contra&ed  itfelf,  another  pain  would  expel  the  fe-. 
cundines.  If  the  funis  fhould  not  break,  after  the 
child  has  cried  a  few  minutes,  or  a  quarter  of  an 
-hour,,  the  circulation  in  it  would  ceafe.  Whether 
it  broke  or  not,  there  would  be  no  danger  of  an  has- 
morrhage  from  it,  provided  it  was  not  cut.  If  th@ 
lecundines  be  wholly  excluded  before  the  pulfaticn 
in  the  navel  firing  is  Hopped,  no  badconiequences 
\vyll  enfue,  the  circulation  will  ftill  be  carried  qn 
betwixt  the  child  and  the  placenta  as  perfectly  as 
if  it  were  in  the  womb,  till  the  child's  lungs  are 
fully  expanded,  and  the  neceffary  alterations  have 
taken  place.  Thefe  circumftances  fhew  the  great 
care  of  nature  in  the  prefervation  of  her  produc-r 
tions. 

The  poor  woman  would  now  be  rejoiced  at  her 
relief  from  pain,  and  her  delivery  from  her  burden, 
but  being  over  fatigued,  (as  well  by  the  agitation  of 
her  mind  as  that  of  her  body,)  (he  would  naturally 
fall  into  a  gentle  flumber.  When  flie  awoke,  her 
next  care  would  be  for  her  tender  offspring.  She 
would  fit  up,  take  it  in  her  arms,  and  apply  it  to 
her  breafls.  where  it  would  find  food  of  a  proper 
quality,  and  in  quantity  fuffrcient  to  fupply  its  trif- 
ling wants.  She  would  not  long  remain  in  this  fitu- 
ation.  She  would  foon  get  up  and  walk  to  procure 
needful  fulienance  for  herfelf. 

This  defcription  is  not  merely  ideal,  it  is  what 

every  day,  with  a  trifling  change  of  circum- 
ftances* 


OF  NATURAL  BIRTHS.  79 

ftances.     The  female  favage,  the  foldier's  wife  up- 
on  her  march,  and  many  women  privately  deliver^ 
ed  of  their  illegitimate    offspring,  experience  the 
truth  of  it ;  but  I  do  not  hence  infer  that  the  cafe 
would  be  the  fame  with  every  woman.     I  know  it 
would  not.     Tender  conftitutions,  hereditary  difor- 
ders  derived  from  the  intemperance  of  our  ancef- 
tors,  and  made  wprfe  by  improprieties  of  drefs,  by 
indolence  and  improper  ciiet,  render  this  impoflible. 
But  we  mould  always  have  nature  in   our  view. 
By  clpfely  fludying  her,  we  learn  in  what  manner 
to  give  her  affiilance  wfcen  fhe  {lands  in  need  of  it. 
Neither  would  I  from  hence  infer,  that  art  is  nev- 
er neceffary .     I  know  it  fometimes  is  in  every  ftage ; 
jn  pregnancy,  in  labour,  and  after  delivery ;  but  it 
frequently  happens   that  thofe  who  are  the  buiieft 
when  there  is   no  neceflity,   are  the  moil  incapable 
of  giving  relief  in  cafes  of  real  danger.     The  prac- 
titioner fiiould  be  well  verfed  in  the  knowledge  of 
anatomy,  phyfiology,   and  the  .mechanical  laws  ; 
he  ftiould  not  only  undcriland  the  theory  and  prac- 
tice of  midwifery,    but  of  phyfic  too  ;  he   Ihould 
have  patience,  experience,  and  humanity  ;  courage 
arid  dexterity  in  operating,   together  with  prefence 
of  mind,  and  fliould  be  in  conilant  pradice.     I  do 
not  fay  that  ftrength  is  neceffary,   dexterity  will 
more  than  fupply  its  place. 

The  ufe  of  inftruments  is   fornetimes  needful, 
ttotwithftanding  any  arguments  to  the  contrary,  but 

the 


80         OF  NATURAL   BIRTHS; 

the  too  free  ufe  of  them  ought  by  no  means  to  be 
encouraged.  They  are  fometimes  unneceflarily 
applied,  and  are  frequently  productive  of  great 
mifchief  ;  but  many  lives,  not  only  of  mothers, 
but  of  children,  have  been  faved  by  them,  of  which 
every  one  mud  be  fenfible,  who  has  been  much 
verfed  in  general  pradice. 

In  all  natural  parturitions  I  would  purfue  the  fol- 
lowing method  :  In  the  beginning  of  the  labour  I 
would  be  fo  far  from  confining  my  patient  to  any 
one  pofition,  that  I  would  not  even  confine  her 
to  a  fmgleroom,  but  would  lether  walkabout  from 
one  apartment  to  another.  Whenever  a  pain  mould 
oblige  her  to  lie  down,  I  would  take  that  oppor- 
tunity of  examination,  that  I  might  know  whether 
the  child  was  in  a  right  pofition,  and  how  faft  the 
labour  was  advancing,  and  this  is  beft  done  when 
the  pain  is  going  off.  As  foon  as  I  was  fatisfied 
of  its  right  pofition,  I  would  acquaint  my  patient 
with  it,  that  I  might  afford  her  every  comfort  in 
my  power  ;  but  I  would  not  encourage  her,  by 
telling  her  that  the  child  would  foon  be  born,  with- 
out there  was  the  greateft  certainty  of  it,  left  me 
mould  be  difappointed,  and  think  the  time  long ; 
and  left,  by  fuch  encouragement,  fhe  ihould  at- 
tempt to  affift  herfelf,  and  thereby  exhauft  her 
ftrength  and  fpirits.  During  the  whole  time  of 
her  travail  fhe  ought  to  enjoy  the  freeft  air;  fhe, 

(houlcl 


OF  NATURAL   BIRTHS.  bt 

ihould  not  be  crowded  with  more  friends  or  attend- 
ants than  neceffity  required,  and  the  door,  and 
even  the  window  of  her  room,  in  fummer  time, 
fhould  be  kept  open.  Too  much  care  cannot  be 
taken  to  prevent  the  air  in  the  room  from  being 
rendered  foul,  or  the  patient  being  overheated  at 
this  time  ;  for  if  her  labour  fliould  prove  tedious, 
and  fhe  fhould  for  many  hours  be  kept  in  a  burn- 
ing heat,  or  in  a  fweat,  the  velocity  of  the  blood 
would  be  much  accelerated,  the  perfpiratory  du6b 
would  be  obflru&ed  by  the  fweat,  and  the  patient 
would  be  much  weakened ;  the  air  of  the  room  al- 
fo  would  be  fo  contaminated  by  fweat,  and  the  per- 
fpiration  from  the  fkin  and  the  lungs  of  the  patient 
and  her  affiftants,  as  not  to  be  foon  purified  again. 
But  the  danger  does  not  flop  here.  Should  this 
treatment  be  continued,  a  fever  is  the  inevitable 
confequence ;  fhould  fhe  be  fuffered  fuddenly  to 
cool,  the  perfpiration  is  flill  more  obflru&ed  and 
a  fever  is  in  this  manner  brought  on.  The  keep- 
ing the  patient  continually  cool,  and  the  air  free 
from  putrid  effluvia  are  matters  of  the  utmoft  con- 
fequence. The  neglect  of  thefe  cautions  often  lays 
the  foundation  of  puerperal  and  miliary  fevers. 

When  the  patient  is  coflive,  a  clyfter*  fhould  be 
adminiflered  to  empty  the  lower  interlines.     This 

will 

*Theelaftic  vegetable  bottles  are  greatly  preferable  to  commoa 
feagsfor  adminiftcring  clyfters. 

F 


82  OF   NATURAL    BIRTHS. 

will  likewife  help  to  remove  thofe  fpafms  which 
are  fo  common  in  the  beginning  of  labour.  If  the 
infant  do  not  advance,  and  the  mother  mould  fuf- 
fer  many  Ihort,  but  tormenting  pains,  without  man- 
ifeft  advantage,  there  will  be  reafon  to  fufpecl;  that 
thefe  pains  are  fpafmodic,  or  what  are  generally  call- 
ed falfe  or  fpurious,  being  only  contractions  of  the 
abdominal  mufcles,  not  of  the  uterus ;  but  this  may 
be  eafily  known  by  examining  whether  the  os  ute- 
ri begins  to  dilate  ;  if  it  do  not,  an  opiate  will  re- 
lieve her,  and  regular  pains  will  probably  follow. 

Should  the  labour  begin  with  a  diarrhea,  the 
fymptom  is  far  from  being  bad,  but  is  frequently 
attended  with  the  happieft  effe6b  by  unloading  the 
inteftines.  If  the  patient  become  too  cool  and  law, 
warmth  and  cordials  may  be  allowed  her,  but 
thefe  mould  be  no  longer  continued  than  abfolute 
neceffity  requires.  As  the  labour  advances  me 
will  feldom  complain  of  cold,  except  me  have  been 
kept  too  hot,  and  have  fweated  profufely.  The 
patient  generally  requires  more  air,  and  can  bear 
more  cold  than  her  attendants. 

Where  the  accoucheur  is  fatisfied  that  the  labour 
is  natural,  and  that  every  thing  is  proceeding  well, 
the  patient  mould  not  be  teazed  by  attempting  to 
haflen  her  delivery,  nor  even  by  too  frequent'  ex* 

animations, 

When 


OF  NATURAL  BIRTHS.  83 

When  the  buftnefs  is  fo  far  advanced  that  there 
is  reafon  to  believe  the  child  will  foon  be  born,  it 
is  in  my  opinion  of  great  bonfequence  that  the  wom- 
an fhoul-d  be  in  an  horizontal  pofition,  and  it  will 
be  moft  convenient  if  fhe  lie  upon  her  fide  with  her 
back  towards  the  pra&itioner.  Placing  the  pa- 
tient upon  her  hands  and  knees  is  not  an  unfa- 
vourable pofition  in  natural  labours ;  and  it  pre- 
vents the  child  from  preffing  too  much  on  the  pe- 
rineum. In  fome  preternatural  cafes  too,  it  is  of- 
ten of  great  fervice.  Other  pofitions  indeed,  fuch 
as  (landing,  fitting,  hanging  by  the  arms  between 
two  perfons,  half  fitting  and  half  lying,  either  up- 
on the  bed  or  on  the  knee  of  an  affiftant  may  be, 
and  I  believe  are  often,  Serviceable  in  expediting  de- 
livery, and  are  therefore  extremely  proper  in  flow 
tedious  labours,  except  at  their  conclufion  ;  but  I 
would  by  no  means  advife  that  the  child  fhould, 
in  any  cafe  whatever,  be  born,  or  the  placenta  ex- 
traded  in  any  of  thefe  pofitions.  Very  hafty  de- 
liveries, efpecially  in  fuch  pofitions,  are  often  of 
dangerous  confequence,  frequently  oceafioning  lac- 
eration of  tiie  perineum  and  fphinfter  ani,  prolap- 
fufes  of  the  vagina  and  anus,  inverfions  of  the  ute- 
rus, retention  of  the  fepundines,  fioodings,  after- 
pains,  fyncopes,  faintings,  and  death  itfelf. 

I  cannot  here  help  condemning  the  free  and  in- 
discriminate  ufe  of  the  greafy  applications,     They 

are 
F  a 


84  OF  NATURAL  BIRTHS. 

are  not  only  frequently  unneceffary,  but  if  they 
be  ufed  in  fuch  quantities  as  to  prevent  or  deftroy 
the  a6lion  of  that  mucus  which  nature  has  prepar* 
ed  for  the  purpofe  of  lubricating  and  moiftening 
the  parts,  they  may  be  prejudicial.  Though,  on 
the  other  hand,  if  there  be  not  a  proper  quantity  of 
this  mucus  fecerned,  or  if  it  be  exhaufted  by  a  te- 
dious labour,  thefe  applications  may  be  proper  and 
even  neceffary  fubftitutes. 
. 

When  the  perineum  begins  to  protrude,  the 
preffure  of  a  hand  againft  that  part  will  give  great 
cafe  to  the  patient  ;  the  degree  of  preffure  rnuil  be 
left  to  the  judgment  of  the  perfon  employed  ;  but 
if  the  pains  be  very  forcing,  it  ought  to  be  fuch  as 
will  prevent  a  too  hafty  delivery.  If  this  caution 
be  obferved,  and  the  patient  be  kept  in  an  horizon- 
tal pofition,  there  will  be  no  danger  of  a  laceration 
of  the  perineum. 
i 

As  foon  as  part  of  the  head  is  produced,  it  is 
the  cuftom  of  many  practitioners  to  feize  hold  of 
It  immediately,  and  to  drag  it  forth  with  the  great- 
eft  expedition,  as  if  the  fafety  both  of  the  mother 
and  the  child  entirely  depended  upon  it. 

This  practice  is   founded,  upon  a  grofs  miftake, 
and  the  patients  often  fuffer  from  this  piece  of  rafh- 
from  many  oWervations  which  I  have  made 

within 


OF  NATURAL  BIRTHS.  85 

within  thefe  few  years,  I  am  convinced  that  upon 
the  management  of  this  part  of  the  delivery  de- 
pends the  eafy  or  difficult  exclufion  of  the  fecun- 
dines,  and  the  prevention  of  afterpains.  Leave 
things  to  nature,  and  in  general  me  performs  her 
work  the  beft  without  afliftance.  After  the  pa- 
tient has  recovered  herfelf  a  little,  the  pain  will 
return,  the  moulders  will  make  their  proper  turns, 
and  be  properly  expelled.  Should  the  navel  firing 
be  wrapt  round  the  infant's  neck  and  moulders,  nay, 
mould  it  even  be  drawn  tight,  the  child  would  not 
for  a  conliderable  time,  fuffer  a*  the  circulation  in 
it  does  not  flop  before  it  has  undergone  a  very  great 
diftenfion*  After  the  child  is  expelled  in  this  grad- 
ual manner  by  the  force  of  the  woman's  pains,  the 
womb  by  degrees  contracts  itfelf  from  its  fundus  ; 
its  neck,  and  even  its  middle,  being  kept  from  con- 
traction by  the  part  of  the  infant  which  remains 
within. 

Where  nature  is  very  flow  in  relieving  herfelf, 
affiftance  ought  to  be  given,  but  not  till  it  is  feen 
how  far  Che  is  able  to  do  without  it. 

The  common  method  of  tying  and  cutting  the 
navel  ftring  in  the  inftant  the  child  is  born,  is  like- 
wife  one  of  thofe  errors  in  practice  that  has  nothing 
to  plead  in  its  favour  but  cuftom.  Can  it  poflibly 
be  fuppofed  that  this  important  event,  this  great 
F  3  change 


M  OF  NATURAL   BIRTHS. 

change  which  takes  place  in  the  lungs,  the  heart, 
and  the  liver,  from  the  ftate  of  a  fetus,  kept  alive 
by  the  umbilical  chord,  to  that  (late  when  life  can- 
not be  carried  on  without  refpiration,  whereby  the 
lungs  muft  be  fully  expanded  with  air,  and  the 
whole  mafs  of  blood,  inflead  of  one  fourth  part,  be 
circulated  through  them,  the  duclus  venofus,  fora- 
men ovale,  du&us  arteriofus,  and  the  umbilical 
arteries  and  vein  muft  all  be  clofed,  and  the  mode 
of  circulation  in  the  principal  vefiels  entirely  alter- 
ed— Is  it  poflible  that  this  wonderful  alteration  in 
the  human  machine  Ihould  be  properly  brought 
about  in  one  inftant  of  time,  and  at  the  will  of  a 
byftander  ?  Let  us  but  leave  the  affair  to  nature, 
and  watch  her  operations,  and  it  will  foon  appeal- 
that  fhe  flands  not  in  need  of  our  feeble  affiftance, 
but  will  do  the  work  hcrfclf,  at  a  proper  time,  and 
in  a  better  manner.  In  a  few  minutes  the  lungs 
will  be  gradually  expanded,  and  the  great  .altera- 
tions in  the  heart  and  blood  veffels  will  take  place. 
As  foon  as  this'  is  perfectly  done,  the  circulation  of 
the  navel  firing  will  ceafe  of  itfelf,  and  then  if  it 
be  cut,  no  hemorrhage  will  enfue  from  either  end : 
notwithstanding  this,  it  will  be  always  advifeable 
to  tie  it,  as  an  hemorrhage  might  come  on  if  the 
circulation  fhould  be  quickened  by  the  warmth  of 
the  clothes  and  the  bed.  If  the  funis  be  cut  imme- 
diately after  the  birth  of  the  child,  or  before  the 
pulfation  in  it  ceafes,  that  end  next  to  the  placenta 

will 


OF  NATURAL  BIRTHS.  87 

will  bleed  about  three  or  four  ounces,  and  if  that 
end  next  to  the  child  were  not  tied,  it  would  in  all 
probability  bleed  to  death. 

Whatever  method  be  purfued  it  is  better  not  to 
tie  that  end  next  to  the  placenta,  for  the  more  it  is 
leflened  by  the  blood  being  drained  from  it,  the 
greater  liberty  is  given  tp  the  uterus  to  contract. 

By  this  ram,  inconfiderate  method  of  tying  the 
navel  firing  before  the  circulation  in  it  is  ftopt,  I 
doubt  not  but  many  children  have  been  loft,  many 
of  their  principal  organs  have  been  injured,  and 
foundations  laid  for  various  diforders. 

When  the  infant  is  removed,  the  fecundines  are 
fometimes  found  wholly  expelled  :  fometimes  the 
placenta  is  extruded  from  the  womb  into  the  vagi- 
na, in  which  cafe  it  is  to  be  handled  gently,  and 
with  great  care  gradually  brought  away,  left  any 
parts  of  the  caduca*,  chorion,  or  amnios,  fhould 
be  left  behind,  for  this  would  occaiion  a  very  pu- 
trid difcharge,  together  with  pain  and  a  fever. 
Thefe  membranes  are  fo  extremely  tender,  that  they 
will  bear  very  little  force,  and  it  frequently  will 
be  many  minutes  before  they  can  be  brought  away 

after 

*  The  third  external  membrane,  which  is  very  fpongy,  was  firil  difcover- 
ed  by  that  great  anatomift,  Dr.  Hunter,  and  is  by  him  very  properly  called 
decidua,  or  cndaca,  as  it  appears  to  be  a  lamella  caft  off  from  the  internal  fur- 
face  of  the  womb. 


88  OF  NATURAL  BIRTH& 

after  the  expulfion  of  the  placenta,  the  fpongycho- 
rion  adhering  fo  clofely  to  the  womb.  Sometimes 
an  interval  of  eight  or  ten  minutes  fucceeds  the  birth 
of  the  child,  when  a  pain  coming  on,  the  fecundines 
will  be  eafily  extracted  by  gently  pulling  the  na- 
vel firing,  and  here  an  eafy  preffure  upon  the  ab- 
domen, by  affi fling  the  uterus  to  contract,  will  be 
of  fervice. 

If  the  placenta  be  Very  large,  a  finger  may  be  in- 
troduced to  bring  down  one  edge  of  it  as  foon  as 
it  is  within  reach.  But  whatever  method  be  made 
ufe  of  to  bring  it  away,  the  patient  mould  continue 
in  an  horizontal  pofition. 

.•  -rj 
In  this  manner  I  have  proceeded  for  feveral  years, 

and  during  that  period  I  can  with  fatisfaftion  de- 
clare, that  in  natural  labours  I  have  never  had  oc- 
cafion  for  the  manual  extraction  of  the  placenta  ; 
I  have  never  left  my  patient  till  it  came  away,  nor 
have  I  ever  been  detained  a  fingle  hour  by  it ;  nor 
fmce  I  pra&ifed  this  method  have  I  often  had  oc- 
cafion  for  the  ufe  of  opiates,  or  any  other  medi- 
cines, to  relieve  the  afterpains,  which  have  general- 
ly been  fo  trifling,  both  with  regard  to  violence 
and  duration,  as  not  to  deferve  notice. 

As  to  laborious  or  preternatural  parturitions, 
they  do  not  fall  under  my  prefent  confideration, 

and 


OF  NATURAL    BIRTHS.  $$ 

and  I  fhall  only  obferve,  that  prefentations  of  the 
feet,  knees,  or  buttocks,  muft  be  treated  in  the 
fame  manner  as  natural  prefentations,  and  the  ac- 
coucheur Ihould  wait  with  patience  till  the  breech  is 
born,  when  it  will  frequently  be  neceffary  to  give 
fome  afTiftance,  left  the  child's  life  mould  be  loft,  by 
its  head  preiling  the  navel  firing  againft  the  pelvis, 
folong  as  to  ftop  the  circulation  in  it. 


C  H  A  P. 


go  PREVENTION    or 

• 

r^M._  rJvn^, 

A 


CHAP.      IV. 


THE  PREVENTION  OF   THE  PUERPERAL, 
MILIARY,  AND  MILK  FEVERS. 

S  foon  after  the  woman  is  deliv- 
ered as  it  can  be  conveniently 
done,  clean  linen  fhould  be  put 
about  her,  fhe  Ihould  be  left  to 
the  moft  perfecl;  quiet  of  body 
and  mind,  that  fhe  may,  if  pofli- 
ble,  get-fome  fleep.  The  child  fhould  be  removed 
into  another  room,  and  no  vifitors,  or  other  per- 
fons,  except  fuch  as  are  absolutely  neceflary,  fhould 
be  allowed  to  enter  the  patient's  chamber.  A  num- 
ber of  people,  befides  preventing  repofe,  foul  the 
air,  and  render  a  frequent  fupply  neceffary.  From 
hence  appears  the  difadvantage  of  a  fmall  apart- 
ment. Where  the  patient  has  it  in  her  option,  I 
would  always  recommend  a  large  lofty  room  upon 
the  firft  chamber  floor,  and  could  wifh  it  (if  in  fum- 
mer)  to  have  a  northern  afpe6fc;  but  if  that  cannot 

be 


PUERPERAL    FEVERS;  Sec.         91 

be  had,  there  fhould  be  window  blinds  placed  on 
the  outfide  of  the  windows,  for  when  they  are  on  the 
infide,  they  do  not  anfwer  the  purpofe  of  keeping 
out  the  heat  of  the  fun.  In  this  room  there  ought 
to  be  no  fire  in  fummer,  and  little  or  none  in  winter 
whilft  the  patient  is  in  bed,  unlefs  fhe  has  been  uf- 
ed  to  fleep  conftantly  with  one  in  her  chamber  ;  for 
though  fires  are  undoubtedly  of  the  greateil  fervice 
in  keeping  up  a  circulation  of  air,  yet  at  the  fame 
time  a  conftant  fire  in  a  fmall  room,  when  a  perfon 
has  not  been  accuflomed  to  one,  may  overheat  the 
patient.  This  I  know  will  be  objected  to  by  the 
nurfes,  upon  .their  own  account,  efpecially  if  they 
be  to  wake,  but  waking  is  what  I  do  not  approve, 
except  on  the  firft  night,  and  then  only  if  the  deliv- 
ery be  late  in  the  evening.  It  will  difturb  the  pa- 
tient much  lefs  if  the  nurfe  have  a  fmall  bed  in  the 
room,  but  I  would  by  no  means  fuffer  the  child  to 
remain  there,  if  accommodations  can  poflibly  be 
had  for  it  in  any  other  part  of  the  houfe.  The  pa- 
tient fhould  not  be  diflurbed  in  the  night,  either  up- 
on pretence  of  giving  her  liquid  or  folid  nourim- 
ment.  If  either  be  neceflary,  me  will  naturally  of 
herfelf  demand  it. 

Much  mifchief  is  often  done  by  binding  the  bel- 
ly too  tight  *.     If  there  be  any  occafion  for  fup- 

port, 

*  ««  This  difeafe  (the  puerperal  fever)  it  muflr  be  acknowledged,  may  fol- 
low a  labour  under  the  beft  circumftances,  but  endeavours  to  dilate  the  o* 

internum, 


g*  PREVENTION    or 

portf,  a  thin  napkin  pinned  very  (lightly  round  the 
waift,is  all  that  is  abfolutely  neceffary.  and  the  foon- 
cr  this  is  difufed  the  better.  But  if  there  really 
were  occafion  for  ftrong  comprefnon,  the  common 
methods  would  be  extremely  inadequate.  The 
compreffion  muft  neceffarily  be  unequal,  the  large 
Jiip  bones  of  women  effectually  preventing  fuch 
means  as  thefe  from  making  an  equal  prelfure  up- 
on every  part  of  the  uterus. 

The  thick  fuftian  waiftcoats  and  petticoats  ufual- 
ly  worn  during  the  lying  in,  are  much  too  warm. 
In  the  whole  article  of  drefs  and  bed  clothes,  noth- 
ing mould  be  added  to  what  the  patient  has  been 
accuftomed  to  in  perfect  health. 

In  a  few  hours  after  delivery,  as  foon  as  the  pa- 
tient has  had  a  little  reft,  fhe  mould  fit  up  in  bed, 
with  a  bed  gown  thrown  over  her  moulders.  If  fhe 
propofe  to  fuckle  the  child,  it  mould  now  be  laid 
to  her  breaftj  whether  there  are  iigns  of  milk  or  no. 
This  mould  be  repeated  four  or  five  times  a  day, 
but  in  the  night  it  is  not  neceffary  either  that  the 
bread  mould  be  adminiflered,  or  that  any  kind  of 
food  mould  be  given  to  the  infant. 

The  patient  ftiould  lie  very  high  with  her  head 
and  moulders,  and  mould  fit  up  in  bed  many  times 

in 

internum,  and  too  hafty  a    feparation  of  the  placenta   will   produce  it,  and 
binding  the  abdomen  tight  after  delivery." 

Denman  on  the  Puerperal  Fever,  p.  18. 


PUERPERAL   FEVERS,  Sec.      93 

In  a  day,  especially  when  fhe  takes  her  food,  and 
as  often  as  fhe  fuckles  her  child,  and  fhould  kneel 
whenever  fhe  has  occasion  to  make  water,  which 
fhould  be  often  done. 

This  frequent  upright  pofture  is  of  the  utmofl 
confequence,  and  cannot  be  to  much  enforced.  It 
prevents  the  lochia  from  ftagnating,  the  flools  and 
urine  from  being  too  long  retained,  and  promotes 
the  contraction  of  the  uterus,  together  with  that  of 
the  abdominal  mufcles. 

Large  quantities  of  caudle,  and  thick  gruel  mix- 
ed with  ale,  wine,  or  brandy,  are  often  very  per- 
nicious. They  clog  the  flomach,  and  pall  the  ap- 
petite. 'Strong  liquors,  as  they  are  apt  to  heat, 
mould  not  be  given  to  the  patient,  unlefs  fhe  has 
been  accuflomed  to  them.  Thin  water  gruel,  well 
boiled  and  flrained,  panada,  fago,  wort,  falep,  bar- 
ley water,  to  which  a  fmall  quantity  of  lemon  juice 
has  been  added  ;  teas  of  all  kinds,  but  particular* 
ly  thofe  of  bitter  antifeptic  herbs,  fuch  as  camo- 
mile,  or  buckbean  ;  coffee,  cocoa,  and  chocolate, 
buttermilk  alone,  or  mixed  with  fpring  water,  im- 
perial, orange,  or  lemonade,  or  plain  toaft  and  wa- 
ter may  be  allowed,  provided  none  of  them  have 
been  found  by  experience  to  difagree  with  the 
patient.  None  of  thefe  liquors  mould  be  given 
hot.  the  cooler  they  are  drank  the  better,  and  they 


94  P  R  E  V  E  N  T  I  O  N   OF 

may  even  be  given  perfectly  cold.  Toafted  bread, 
feabifcuit,  or  fomething  folid  fhould  be  taken  to  pre- 
vent faintnefs  ;  and  as  foon  as  the  patient  has  an 
appetite,  her  food  fhould  confift  of  boiled  bread 
pudding,  boiled  fowls,  lamb,  or  veal,  vegetables, 
and  ripe  fruit.  Too  much  animal  food  fhould  not 
be  allowed,  and  it  mould  never  be  eat  oftener  than 
once  a  day,  and  then  not  without  bread  and  greens, 
roots,  or  fome  kind  of  vegetables.  The  North  A- 
merican  fago  powder,  diflblved  in  boiling  waters 
forms  a  moil  agreeable,  tranfparent,  mucilaginous, 
vegetable  jelly, ,  which  is  demulcent,  reftorative, 
and  nutritious  ;  obtunding  the  acrimony  of  the 
fluids,  and  correcting  putrefaction  ;  of  a  more 
pleafant  tafte.  in  my  opinion,  thanfalep,  and  much 
cheaper  than  the  foreign  falep,  though  not  fo  cheap 
as  that  produced  in  our  own  country,  and  prepar- 
ed in  the  manner  directed  by  Mr.  Moult  in  the 
Phil.  Tranf.  vol.  59.  p.  j. 

Whatever  water  the  patient  drinks,  either  alone 
or  in  gruel,  teas,  &c.  fhould  not  be  fuch  as  is  taint- 
ed with  any  putrid  animal  or  vegetable  fubflances, 
which  is  generally  the  cafe  in  all  refervoirs  of  flag- 
nant  water  and  in  rivers  adjoining  to  large  towns. 

Broths*,  or  foups  made  of  flem  meal,  efpecially 
if  given  warm,  are  improper,  as  they  are  apt  to 

throw 

"  *  The  French,  and  many  other  nations,  give  their  patients  meat  foups,  in 
"  acute  difeafes,  and  after  capital  operations,  and  they  allow  them  but  little 

"  bread, 


PUERPERAL  FEVERS,  &c.      95 

throw  the  patient  into  a  fweat,  and  promote  putre- 
faftion.  If  the  patient  cannot,  or  do  not  choofe  to 
fuckle  her  child,  fhe  fhould  be  very  abftemious  in 
her  diet  ;  but  if  Ihe  fuckle  it,  a  much  greater  lati- 
tude may  be  allowed. 

Fruits,  vegetables,  and  all  kinds  of  acid  or  acef- 
cent  food  have  generally  been  denied  to  nurfes, 
upon  a  fuppofition  that  they  created  acidities  in 
the  childrens'  bowels.  This  in  fome  conflitutions 
they  certainly  do,  but  the  rule  is  by  no  means  gen- 
eral. I  have  known  nurfes  abounding  in  acrid  pu- 
trid bile  indulge  freely  in  thefe  kinds  of  food  with 
great  advantage  to  themfelves,  and  with  no  difad- 
vantage  to  their  infants,  as  plainly  appeared  by 

the 

"  bread,  or  other  preparations  of  vegetable  fubftances  ;  but  thefe  foups,  with- 
11  out  bread,  do  not  nourifh  the  patient  fufficiently,  and  tend  too  much  to 
"  the  putrefcent ;  and  this  is  one  reafon  why  more  fkk  die  in  the  French, 

"  than  in  the  Britifh  hofpitals." 
i 

Monro  on  the  difeafes  of  the  Britifh  military 

hofpitals,  Note  top.  373, 

Dr.  Lind,  fpeaking  of  a  marine  hofpital  ere6led  at  Jamaica,  upon  a  moft 
unhealthy  fpot  of  ground,  fays,  "  The  recovery  of  patients  in  that  hofpital 
"  was  obferved  to  be  very  tedious,  and  uncertain  ;  the  leaft  indifcretion  or 
"  irregularity  brought  on  a  relapfe.  After  a  flux  had  been  flopped  fome 
"  days,  the  eating  of  any  fort  of  food,  whicfi  had  a  putrid  tendency,  fuch  as 
"  even  a  mefs  of  broth,  would  fometimes  in  a  few  hours  bring  on  a  return  of 
i{  the  difeafe,  accompanied  with  all  its  violent  fymptoms." 

Effay  on  the  difeafes  of  the  Europeans,  p,  1 74. 


96  PREVENTION  o* 

the  childrens'  never  parting  with  green  fiools  dur- 
ing the  time  of  their  being  fuckledt. 

The  heat  of  the  room  ought  to  be'  fo  tempered, 
that  the  patient  may  neither  be  chilled  with  cold, 
nor  yet  fuffer  from  fweat  or  burnings.  She  fhould 
be  kept  in  that  degree  of  heat  that  approaches  near- 
-eft  to  the  ftandard  of  health.  Some  have  kept 
fchemfelves  in  a  conftant  gentle  fweat,  or  diaphore- 
fis,  as  it  is  called,  in  order  to  prevent  a  rigour,  or 
cold  fhivering  fit  ;  but  it  is  well  known  that  no  de- 
gree of  heat,  let  it  be  ever  fo  .great,  will  prevent  the 
rigour,  either  in  a  puerperal  woman,  or  even  in  a 
common  ague.  There  have  been  inflances  of  per- 
ibns  having  rigours  in  the  hot  fweating  room  of  a 
bagnio,  and  I  have  been  informed  that  thefe  have 
bee.n  the  moft  dreadful  ;  rigours  and  even  com- 
mon agues  are  frequent  in  the  hotteft  climates. 
The  patient's  ikin  mould  be  foft,  but  not  fo  much 
as  moid  ;  her  linen  being  damp  with  fweat  will 
render  her  liable  to  catch  cold  ;  (he  will  be  fenfible 
of  every  breath  of  air,  and  cannot  rife  or  even 
turn  herfelf  in  bed  without  danger.  The  apart- 
ment cannot  be  ventilated,  nor  even  a  curtain  be 
undrawn  ;  confequently  me  becomes  weak,  the 
fibres  are  relaxed,  the  lochia  becomes  accu- 
mulated and  acrid,  are  reabforbed  into  the  cir- 
culation, 

f  .Are  not  the  four  green  flools  of  children  oftener  owing  to  weaknefsand 
relaxation  in  their  digeftive  organs,  and  the  inert  quality  of  their  bile,  than 
to  the  acefcency  of  the  milk  ?  and,  Do  we  not  often  fee  them  change  for 
the  worfe,  even  though  the  nurfe  has  made  no  alteratioain  her  diet,,  nor  has 
tailed  aHy  kind  of  acefcent  food  ? 


PUERPERAL  FEVERS.          9; 

culation,  and  occafion  a  fever.  Cuftom  in  this  I 
know  is  much  againft  me,  as  well  as  in  many  oth- 
er particulars  ;  but  I  have  hundreds  of  evidences 
to  prove  that  fweating  is  not  neceffary  even  in  the 
fmalleft  degree. 

Much  mifchief  appears  to  have  been  done  a- 
mongft  ignorant  people  by  confounding  the  ideas 
of  perfpiration*,  and  fweat.  The  difference  be- 
tween them  has  been  remarked  by  fo  great  a  num- 
ber of  authors,  that  quotations  would  be  endlefs  ; 
it  is  fufficient  for  common  ufe  to  obferve.  that  per- 
fpiration is  that  infenfible  difcharge  of  vapour 
from  the  whole  furface  of  the  body  and  the  lungs 
which  is  conftantly  going  on  in  a  healthy  ftate  ; 
that  it  is  always  natural  and  always  falutary ;  that 
fweat  on  the  contrary,  is  an  evacuation,  which  nev- 
er appears  without  fome  uncommon  effort,  or  fome 
difeafe  in  the  fyftem  ;  that  it  weakens  and  relaxes^ 
and  is  fo  far  from  coinciding  with  perfpiration,  that 
it  obftrufts  and  checks  it. 

With 

*  Dr.  Home  has  proved  by  feveral  experiments,  that  a  free  perfpiratioa 
does  not  depend  fo  much  upon  the  heat,  as  the  drynefs  of  the  air  ;  he  fays, 
"  Moifture  flops  perfpiration  in  a  great  degree.  Dr.  Hales  has  obfexved 
that  moifture  has  the  fame  effeft  on  the  perfpiration  of  plants." 

Med.  Fa£U  and  Experiments,  p.  245. 

A  little  farther  he  obferves,  that  "  by  thefe  two  experiments  it  appear? 
that  the  perfpiration  is  greater  in  froft  than  in  open  weather," 

Ibid,  p,  tfr 

G 


98  PREVENTION  OF 

With  regard  to  fweating  in  febrile  diforders,  ma< 
•  ny  contrary  opinions  have  prevailed.  It  was  in- 
troduced with  the  notion  of  carrying  off  by  its 
means  the  morbid  matter  which(>was  fuppofed  to  be 
the  occafion  of  all  fevers.  Later  obfervation  has 
however  found  it  prejudicial  in  many  cafes  ;  and 
fome  have  gone  fo  far  as  to  deny  its  utility  in  any. 
I  (hall  make  quotations  from  fome  of  thofe  au- 
thors *  who  have  confidered  this  matter  the  moft 
clearly  and  particularly. 

From 

*  "  Hippocrates  relates  the  cafes  of  fome  patients,  whofe  fevers  were  ter- 
minated after  the  eruption  of  fweat,  whether  that  fweat  really  put  a  period 
to  the  difeafe,  or  only  appeared  at  its  end  ;  as  it  happened  in  the  inftances 
recorded,  lib.  i.  patient  6,  7.  lib.  2.  patient  7.  n,  12.  in  which  patients 
the  fever  feems  rather  to  be  terminated  by  an  eruption  of  blood  than  of 
fweat  ;  for  fweat,  fo  far  as  I  can  perceive,  is  not  by  Hippocrates  always  pro- 
pofed  as  an  inftrument  by  -which  the  difeafe  is  cured,  but  only  as  a  mark  or 
fign  by  which  its  event  or  termination  may,  with  the  greateft  certainty, 
be  prognofticated.  For  this  reafon,  in  thofe  books  of  his  which  are  account- 
ed genuine,  he  no  where  mentions  fudorific  medicines  ;  and  even  in  thofe 
-works  which  ar«  falfely  afcribed  to  Hippocrates,  there  is  only  once  mention 
made  of  a  fweat  procured  or  forced  by  medicines  ;  for  the  author  of  his  fec- 
ond  book  of  epidemics  orders  a  fweat  to  be  procured  by  carefully  covering 
the  patient  with  the  bed  clothes,  and  exhibiting  meal,  mixed  in  rich  and 
generous  wine  ;  nor  does  he  even  prefcribe  thefe  meafures  as  proper  to  be 
taken,  except  in  thofe  fevers  which  arife  from  laflitude,  or  fome  other  fimil- 
ar  caufe,  fuch  as  thofe  commonly  called  diary  fevers, 

"  Internal  medicines  for  producing  fweats  were  fo  little  in  ufe  among 
the  ancients,  that  Celfus  has  not  a  fingle  word  upon  this  fubjeft.  If  there- 
fore fweats  are  of  any  ad%rantage  in  fevers  of  this  kind,  they  feem  to  derive 
the  efficacy  from  nature  alone.  During  thofe  fweats,  perhaps,  the  peccant 
frnatter  might  be  eafily  diflipated,  and  carried  through  the  fkin,  either  on  ac- 
count  of  the  temperance  of  the  climate,  or  by  the  good  conftitutions  of  the 

patients, 


PUERPERAL  FEVERS,  Sec.      99 

From  the  whole  we  may  conclude,  i.  That 
fweating  in  bed  in  a  confined  atmofphere  muft  be 
very  detrimental  to  a  perfon  in  health,  may  bring 
on  many  diforders,  but  cannot  prevent  any. 

2.  That 

patients,  -which  were  not  yet  corrupted  by  (loth  tfn-d  luxury  :  but  in  the  pref* 
ent  condition  of  mankind,  we  in  vain  expeft  the  folution  of  a  difeafe  by 
fweat,  whether  fpontaneous  and  natural,  or  procured  by  art  :  and  I  believe 
I  may  juflly  venture  to  affirm,  that  in  violent  fevers  the  patients  are  rarely 
reftored  by  fweats  alone. 

Friend  on  Fevers,  Comment.  3. 

*«  But  whereas  the  hot  regimen  is  ftill  too  much  in  ufe,  it  may  not  be 
amifs  to  examine  a  little  more  narrowly  how  it  comes  to  pafs  that  fo  many 
ill  confequences  flow  from  it. 

"  Nature  then  is  fcarce  ever  able  to  expel  the  febrile  matter  by  fweat,  be- 
fore it  has  taken  up  a  proper  time  for  its  maturation,  except  in  the  plague  ; 
fo  that  fweats,  which  of  their  own  accord  flow  largely  in  the  beginning  of 
a  difeafe,  do  not  carry  off  the  fever,  but  prognofticate  a  long  and  dangerous 
diforder,  and  probably  are  the  occafion  of  it.  They  likewife  render  the  pa- 
tient coftive  in  the  beginning,  and  in  putrid  fevers  frequently  caufe  a  diar- 
rhea towards  the  crifis,  whereas  thofe  perfons  generally  efca-pe,  and  moil 
eafily  get  free  from  a  fever,  to  whom  the  very  contrary  of  this  happens, 

«'  In  thefe  climates  there  is  no  neceffity  that  perfons  in  perfect  health 
fliould  have  a  vifible  moifture  on  their  {kin,  but  in  very  warm  countries,  in 
hot  days  this  fcems  to  be  of  great  fervice.  In  Egypt  during  the  fecond  part 
of  the  fummer,  every  one  fweats  profufely  feveral  times  a  day,  and  at  that 
feafon  the  inhabitants  always  enjoy  the  moft  perfect  health, 

*'  Such  an  error  is  never  more  frequently  committed  than  in  giving  what 
they  call  cordial  and  fudorific  medicines  in  the  beginning  of  fevers^for  this 
method  promifes  an  eafy  and  ple-afant  cure,  and  is  agreeable  to  the  opinion 
of  the  vulgar.  Cuftom  has  made  it  familiar,  and  the  patient  finds  himfelf 
relieved  when  the  fweats  begin  to  flow,  and  i$  they  ftop  he  is  abundantly 
fcotter,  more  thirfty,  and  refllefs," 

"  But 

G  a 


loo  PREVENTION  OF 

2.  That  fweats  are  particularly   detrimental  to 
K omen  in  the  puerperal  ftate,  as  they  render  them 
coftive,  caufe  a  ftagnation  and  abforption  of  the 
lochia,  relax  and  weaken  the  patients,  and  make 
them  fo  fufceptible  of  cold,  that  the  air  cannot  be 
renewed,  nor  the  common  offices  of  life  be  per- 
formed without  danger. 

3 .  That  fweats  are  very  detrimental  in  the  be- 
ginning of  all  low  nervous,   or  putrid  fevers,  but 
particularly  ,thofe  of  lying  in  women,  which  if  not 

in 

<{  But  fweats  which  are  very  eafily  brought  on  in  the  beginning  of  a  dif- 
rafe,  will  frequently  quite  difappear  as  it  advances  towards  the  height,  fo  as 
not  to  be  recalled  by  the  warmefl  medicines  ;  and  though  they  fhould  con- 
tinue to  flow,  they  will  certainly  bring  along  with  them  thofe  bad  fymp- 
toms  which  have  been  mentioned  before.  Although  the  ancients,  the  moft 
fludious  of  nature,  never  admitted  this  method  of  pra&ice,  and  the  modems, 
more  intimately  inflru&ed  in  the  facred  myftery  of  phyfic,  always  rejected 
it,  yet  it  is  never  to  be  expected  that  the  old  women,  who  have  a  licence  of 
flaying  mankind  with  impunity,  fhould  ever  fuffer  themfelves  to  be  taktn 
off  from  their  method  of  cure  ;  but  it  is  to  be  wifhed  that  Phyficians,  who 
follow  the  guidance  of  reafon,  would  throw  afide  their  prejudices,  and  weigh 
the  matter  with  that  carefulncfs  it  deferves,  and  banifh  this  pernicious  meth- 
od from  that  art  which  promifes  health  to  mankind." 


<c  Plerumque  in  piincipio  morborum  acutorum  nocet  (fudor) ;  reftius 
tune  fuccedit,  quando  facia  co&ione  materies  morbi  per  cutem  expelli  para- 
ta  eft.  Ipfe  tamen  per  feipfura  neque  petechias,  neque  miliarem  morbum  fa- 
nat,  neque  variolas,  et  periculofe  per  calida  medicamenta  quaeritur,  ut  ne  cali- 
dws  quidem  potus  nimis  tutus  fit,  quern  vidi,  de  mitiflimis  herbis  decoftum, 
bis  intra  triduum  in  delirium  atrox  hominem  miliari  febre  laborantem  con- 
jeciffe  ;  qui  idem  refrigerations  undique  quaefita  levatus,  denique  convaluit.'* 

Haller,  Elem.  Phyfiol.  torn.  v.  p.  51. 


PUERPERAL  FEVERS,  &c.     101 

in  the  beginning,  are  always  in  their  termination  of 
one  of  thofe  claffes,  if  they  continue  any  length  of 
time. 

4.  That  the  rigour  in  the  paroxifm  of  an  ague 
fe  terminated  by  a  fweat,  but  the   continuance  of 
that  fweat  will  not  prevent  a  frefh  acceffion. 

5.  That  when  the  morbific  matter  is  thrown  off 
by  the  fkin,  it  muft  be  an  a&  of  nature,    and  the 
moft  probable  means  of  promoting  that  end  is  to 
keep  the  patient  in  that  kind  of  heat  which  neareft 
approaches  the  ftandard  of  health,  at  the  fame  time 
promoting  a  free  circulation  of  air,  that  thofe  mor- 
bific particles  and  the  human  effluvia  may  not  flag- 
nate  about  the  patient,  but  be  carried  off,  and  their 
abforption  prevented  by  an  effectual  ventilation. 

The  chamber  door,    and  even  the  windows,  if 

ff '  ~ '. 
A  every  day. 

There  mould  be  no  board  or  other  contrivance  to 
flop  the  chimney,  on  the  contrary,  it  mould  be 
quite  open,  that  it  may  act  as  a  ventilator.  The 
Curtains  mould  not  be  clofe  drawn,  that  the  efflu- 
via may  have  the  liberty  of  efcaping.  Carpets  are 
very  ufeful,  as  they  render  wafhing  the  room  un- 
neceffary,  for  moifture  ought  as  carefully  to  be  a- 
voided  as  heat  or  cold,  therefore  it  ought  not  to  be 
waihed  upon  any  account  as  long  as  the  pntient 
G  3  ftays 


102  .PREVENTION  OF 

flays  in  it.     The  room  fhould  be  brufhecl,  and  the 
carpets  taken  out  every  day,  to  be  cleaned  and  aired. 

The  lying  in  chamber  mould  in  eveiy  refpecl:  be 
as  fweet,  as  dean,  and  as  free  from  any  difagreea- 
ble  fmell,  as  any  other  part  of  the  houfe.  The  pa- 
tient mould  often  be  fupplied  with  clean  linen,  for 
cleanlinefs,  and  free,  pure,  andinfome  cafes  cool  air, 
are  the  greatefl  neceffaries  in  this  fituation ;  and, 
upon  the  flri&eft  examination,  it  appears  evidentto 
me  that  there  never  was  a  miliary  eruption  produc- 
ed without  a  fweat,  nor  a  puerperal  fever  without 
either  foul  air,  an  accumulation  of  excrements  in 
the  inteflines,  or  confinement  of  the  patient  to  an 
horizontal  pofition,  thereby  occafioning  a  ftagna- 
tion  and  an  abforption  of  acrid  matter,  except  in 
cafes  where  violence  had  been  ufed,  either  in  dilat- 
ing the  os  internum,  or  in  the  delivery  of  the  child  or 
the  placenta,  or  from  fome  very  great  imprudence. 

The  fooner  'flie  gets  out  of  bed  after  her  delivery, 
the  better  ;  even  on  the  fame  day  if  poflible ;  fhe 
mould  not  defer  it  beyond  the  fecond  or  third 
at  the  farthereft,  and  then  if  it  be  winter  time,  it 
will  be  neceflary  to  have  a  fire. 

Clean,  well  aired  meets,  mould  now  be  laid  upon 
the  bed,  but  by  no  means  fuch  as  have  been  lain  in 
fince  their  wafhing. 

if 


PUERPERAL    FEVERS,    &c.         103 

If  the  patient  have  not  every  day  a  ftool,  one 
ought  daily  to  be  procured.  Clyfters  are  very 
proper ;  they  will  not  only  procure  ftools,  but  by 
paffing  along  the  arch  of  the  colon,  aft  as  fomenta- 
tions to  the  whole  abdomen,  without  any  griping  or 
other  difagreeable  commotions.  For  this  purpofe 
warm  water  is  generally  fufficient ;  but  if  the  feces 
be  too  much  hardened,  milk,  oil,  and  brown  fugar, 
or  the  decoffi.  commun.  pro  clyjl.  with  a  very  fmall 
quantity  of  the  fyrup  of  buckthorn,  may  be  admin- 
iilered  :  nothing  of  a  more  flimulating  nature  fhould 
be  ufed ;  it  is  better  to  repeat  thefe  clyfters,  in  which 
cafe  their  end  will  certainly  be  anfwered.  Should 
the  patient  have  an  averfion  to  thefe  applications,, 
or  if  a  clyfler  cannot  be  adminiflered,  either  upon 
account  of  lacerations  in  the  fpbinfter  anni,  or 
from  any  other  caufe,  it  will  then  be  neceffary  to 
give  a  little  manna,  lenitive  elecluary,  rhubarb,  caf- 
tor  oil,  Rochelle  falts  or  magnefia.  Broth  clyfters  are 
very  improper,  as  they  too  much  encourage  putre- 
faction, and  ftrong  purging  medicines,  either  by 
the  mouth  or  clyflerwife,  mould  not  be  given  in  the 
early  days  of  childbed,  as  they  may  promote 
the  abforption  of  the  lochia ;  but  when  an  abforp- 
tion  has  once  taken  place,  then  purgatives  may  be 
given  with  the  greateft  advantage,  to  prevent  the 
matter  from  being  depofited  upon  theomentum,  per- 
itoneum, or  any  of  the  vifcera.  The  ftools,  urine, 
and  foul  linen,  mould  not  be  permitted  to  remain 

in  the  apartment. 

G4  If 


104  PREVENTION    OF 

If  the  lochia  do  not  flow  fo  plentifully  as  may  "be 
expefted,  or  if  they  entirely  flop,  no  irritating, 
forcing  medicines  mould  be  ufed.  They  nev- 
er do  any  good,  and  are  often  produ&ive  of  much 
rnifchief.*  If  the  patient  be  otherwife  as  well 
as  can  be  wifhed,  no  regard  needs  to  be  paid  to 
this  circumflance.  We  not  only  find  this  evacua- 
tion very  different  in  different  women,  but  even  in 
the  fame  woman  in  different  lyings  in,  from  which 
{he recovers  equally  well.  I  have  frequently  known 
this  difcharge  to  flop  the  very  firft  day,  without  the 
leaflbad  confequence.  If  fhe  have  other  complaints, 
the  caufes  of  thofe  complaints  muft  be  inquired 
into,  and  the  diforder  remedied ;  if  this  be  done, 
the  floppage  of  the  lochia  will  be  of  little  or  no 
confequence,  and  when  the  caufe  is  taken  away 
they  will  fometimes  flow  again.  It  is  not  a  prima- 
ry difeafe  :  the  effe6l  is  miflakenfor  the  caufe.  Get- 
ting out  of  bed  is  themofl  effeftual  and  fafefl  method 

of  promoting  the  lochia, 
f 

The  patient's  recovery  does  not  depend  upon  the 
quantity  of  the  difcharge,  for  the  evacuation  itfelf 

will 

*  c<  We  have  alfo  been  taught  to  endeavour  flrcnuoufly  to  remove  every 
obftacle  to  the  regular  procedure  of  the  lochia.  But  it  unfortunately  happens 
that  alraoft  all  the  medicines  recommended  as  emmenagogues  are  improper 
in  every  inflammatory  flate  of  the  blood,  and  experience  proves,  that  in  this 
cafe  all  the  fymptoms  are  aggravated  by  their  ufe. 

ct  It  may  not  be  amifs  to  obferve,  that  either  a  great  or  a  little  quantity  of 
the  lochia,  unattended  with  other  iymptomsj  is  not  to  be  looked  upon  as  a 

Difeafe,  or  meddled  with." 

Dcnraan  on  the  Puerperal  Fever,  p.  14. 


PUERPERAL    FEVERS,  &c.         105 

not  prevent  either  the  puerperal  or  miliary  fever. 
It  is  well  known  that  the  laborious  hard  working 
women  (who,  ufing  much  exercife,  feem  to  live  in 
a  ftate  nearly  approaching  to  that  of  nature)  have 
not  fo  large  a  quantity  either  of  the  menfes  or  lochia 
as  the  more  delicate  part  of  their  fex,  yet  they  com- 
monly enjoy  a  good  flate  of  health,  and  recover 
from  their-Jyings  in  much  fooner  than  others.  They 
are  the  very  reverfe  of  thofe  whofe  fibres  are  relaxed 
by  a  fedentary  inactive  life ;  and  I  have  frequently  ob- 
ferved,  that  fuch  as  have  the  lochia  in  greateft  abund- 
ance are  moft  liable  to  puerperal  fevers.  It  mufl 
however  be  owned,  that  after  thefe  fevers  are  com- 
menced, floppages  are  not  uncommon.  All  I  would 
here  inculcate  is,  that  the  danger  does  not  arife  from 
the  fmallnefs  of  the  quantity  of  the  difcharge,  but 
from  its  ftagnation,  whereby  it  becomes  acrid,  and 
in  this  flate  is  again  abforbed  into  the  circulation. 
When  the  difcharge  is  great,  but  does  not  weaken 
the  patient,  no  remedy  is  neceflary  ;  when  it  does, 
an  infulion  of  the  external  rind  of  oranges,  with  the 
bark*,  and  the  acid  elixir  of  vitriol,  may,  during  any 
period  of  the  puerperal  flate,  be  given  with  fafety 
and  advantage.  To  thefe  may  be  added  a  ftrength- 
ening  incraffating  diet,  blomange,  flummery,  fago, 

falep, 

*  The  Peruvian  Bark  has  been  given  to  a  woman  fuccefsfully  in  the  quanti- 
ty of  a  drachm  every  three  hours,  two  days  after  her  delivery,  for  twenty  four 
Hours,  without  lefTening  the  lochia  :  and  it  has  frequently  been  given  to  other* 
during  their  catamenia  without  the  lead  interruption  of  them. 

Med.  Tranfa&,  vol.  i.  article  21.  by  Dr.  W.  Hcberden. 


io6  PREVENTION  OF 

falep,  jellies  of  calves'  feet,  hartfhorn  or  ifinglafs. 
When  this  diforder  arifes  from  irritations  and 
fpafms,  occafioned,  as  is  very  often  the  cafe,  by  too 
great  an  acrimony  of  the  fluids,  opiates,  and  the 
tincture  of  rofes  well  acidulated  are  generally  fuc- 
cefsful.  If  the  evacuation  fhould  be  exceffive,  pro- 
vided the  patient  be  kept  cool,  fhe  may  be  indulged 
with  reft  in  an  horizontal  pontion,  and*more  power- 
ful aflringents  mufl  be  ufed,  fuch  as  alum  poffet, 
and  the  lixivium  martis,  given  to  the  quantity  of 
fifteen  or  twenty  drops  three  or  four  times  a  day. 
Linen  cloths  or  fponge,  dipt  in  cold  vinegar  J,  or 
water,  fhould  be  frequently  applied  to  the  lower 
part  of  the  abdomen,  and  to  the  loins,  or  what  is 
ilill  more  effectual,  an  ox's  bladder  half  filled  with 
cold  water  may  be  applied  to  the  forepart  of  the 
abdomen,  the  patient  at  the  time  lying  on  her  back, 
which  by  its  coldnefs,  and  likewife  by  its  weight, 
making  an  equal  preffure  upon  the  uterus,  helps 

it  to  contract/ 

If 

^  Injefling  cold  water  into  the  uterus  is  recommended  by  that  celebrated 
profeffor  of  midwifery  at  Edinburgh,  Dr.  Young,  but  it  is  a  remedy  I  have 
never  tried.  "  Verum  arteriolas  rubras  conftringendo  ad  haemorrhagias. 
fiftendas  optime  accommodatum  eft  frigus.  Ad  hoc  emciendum,  applicatio 
topica,  in  partis  effeftae  vicinia,  maxime  convenit.  In  epiftaxe,  remediura 
apudornnes  notiflimum  eft  aqua  frigid^  quae  ope  lintei  fronti  vel  nuchas  im- 
ponitur  :  nee  ullumquidem  efficacius  invenitur.  Nee  rarius,  neque  minors 
fucceffu,  in  menorrhagia  adhibetur  :  interdum  enim,  multis  aliis  incafium 
tentatis,  aqua  gelida  dorfo,  modo  fupra  ditto,  applicata  fperatum  auxilium 
przbet.  In  lochiorum  profluvio  immodico  &  periculofo  eandem  multum 
laudat  Cl.  profeffor  nofter  Young  ;  quam  in  uterum,  per  horae  quadrantcm, 

coutinenter  injicere  jubet." 

Tucker  Differt.  Med.  Inatig.  p.  at. 


PUERPERAL  FEVERS,  Sec.        107 

If  the  patient  faint  away  t  me  muft  not  be  roufed 
by  volatiles,  or  any  thing  elfe  applied  to  her  nofe, 
nor  by  wine  or  other  cordials  given  internally.  J 
have  frequently  known  fainting  fits  put  an  immediate 
flop  to  violent  floodings,  by  giving  the  blood  time 
to  coagulate  in  the  uterine  Teins  ;  and  large  dofes 
of  nitre*  have  often  afforded  inftant  relief ;  which 

I 

t  "  And  upon  thisoccafion  I  recollected  a  remark  of  Dr.  Hunter's,  \vhick 
is,  that  the  faintnefs  which  comes  on  after  haemorrhages,  inftead  of  alarming 
the  byftanders,   and  making  them  fupport  the  patient  by  {Simulating  medi- 
cines, as  fpirits  of  hartfhorn  and  cordials,  fhould  be  looked  upon  as  falutary, 
as  it  feems  to  be  the  method  nature  takes  to  give  the  blood  time  to  coagulate." 
Hewfon's  Experimental  Inquiry  into  the 
Properties  of  the  blood,  p.  68. 

*'  From  this  circumftance,  that  the  difpofition  of  the  blood  to  coagulate  Is 
increafed  as  the  animal  becomes  weaker,  we  may  draw  an  inference  of  fome 
ufe,  with  regard  to  the  (lopping  of  haemorrhages,  viz.  not  to  roufethe  patient 
by  ftimulating  medicines,  nor  by  motion,  but  to  let  that  langour  or  faintnefs 
continue,  fince  it  is  fo  favourable  forthat  purpofe  ;  and  alfo  that  the  medicines 
likely  to  be  of  fervice  in  thofe  cafes,  are  fuch  as  cool  the  body,  leflen  the 
force  of  the  circulation,  and  increafe  that  languor  or  faintnefs.  For  in  proper- 
tion  asthefe  effefts  are  produced,  the  divided  arteries  become  more  capable  of 
contracting,  and  the  blood  more  readily  coagulates ;  two  circumftances  that 
feem  to  concur  in  clofmg  the  bleeding  orifices. 

"  Befides  giving  ftimulants  and  cordials  to  counteract  the  fainting,  it  is  a 
common  practice  in  many  parts  of  England,  to  give  women  who  are  flood- 
ing, confiderable  quantities  of  port  wine,  on  a  fuppofition  that  it  will  do  them 
ferv'.ce  by  its  aftringency.  But  furely,  from  its  inereafing  the  force  of  the 
circulation,  it  muft  be  prejudicial  in  thofe  cafes.  Perhaps  many  of  the  reme- 
dies called  ftyptics  might  be  objected  to  for  the  fame  reafon." 

Ibid.  71. 

*  "  It  therefore  {hews  how  much  languor  and  faintnefs  mould  be  en- 
couraged in  haemorrhages,  and  how  carefully  we  fhould  avoid  giving 
»ny  thing  that  can  ftimulate,  or  roufe  the  patient ;  that  the  medicines  that  arc 

likely 


io8  PREVENTION    or 

I  fuppofe  is  owing  to  the  power  which  Dr.  Alexan- 
der jufty  afcribes  to  it,  of  almoft  inftantly  retard- 
ing the  velocity  of  the  circulation,  and  of  furprifing- 
ly  diminifhing  the  number  of  pulfations ;  but  it 
jfhould  be  given  immediately  after  being  diflblved, 
as  the  fame  Gentleman  has  obferved,  that  it  then 
pofleffes  that  power  in  a  greater  degree.  In  con- 
flitutions  that  are  fubjeft  to  acrid  putrid  bile,  nitre 
is  improper,  as  it  generally  difagrees  with  the  ftom- 
ach. 

If  the  difcharge  of  the  lochia  be  moderate,  the 
patient  mould  not  only  fit  up  often,  but  mould  ev- 
ery day  get  out  of  bed,  flaying  up  as  long  as  fhe  can 
without  fatigue,  and  continuing  it  a  little  longer 
every  day  than  fhe  had  done  the  day  before. 
A  very  convenient  eafy  chair  has  been  invented,  to 
which  a  foot  board  is  adapted,  not  only  preferving 
the  legs  and  feet  from  cold,  but  by  the  means  of  two 

ft  raps, 

likely  to  be  of  feryice  are  nitre  and  the  acids,  or  fuch  as  cool  the  body,  or 
have  the  property  of  diminifhing  the  force  of  the  circulation,  or  of  increaf- 
ing  that  languor,  or  faintnefs  ;  that  all  anxiety  and  agitation  of  mind  mould, 
as  much  as  poflible,  be  prevented,  left  they  increafe  the  circulation,  that  all 
rnufcular  motion  Ihould  be  avoided  for  the  fame  reafon." 

Hcwfon's  Experimental  Inquiry,  p.  i©o. 

Dr.  Dickfon  in  the  Mcd.  Obf.  and  Inq.  vol.  4.  art.  16.  p.  320,  fpeaking 
of  nitre  given  in  the  form  of  an  eleftuary  with  conferve  of  rofes,  fays,  {<  I 
have  found  nitre  too  adminiftered  in  this  manner  of  fingular  fervice  in  ute~ 
rine  kezmorrkages,  but  only  fo  far,  if  my'pbfervation  is  correft,  when  there 
was  a  feverimnefs  and  hardnefs  of  pulfe;  for  in  other  cafes  the  elix.  vitriol. 
*cid.  given  in  fmall  quantities,  and  very  frequently  r-rpcatcd,  was  attended 
with  much  greater  benefit," 


PUERPERAL     FEVERS,  Sec.       109 

ftraps,  fo  contrived  that  the  back  of  the  chair  may 
be  depreffed,  and  the  foot  board  raifed  at  pleafure. 
By  means  of  this  contrivance,  if  the  patient  be 
faint  or  fatigued  with  fitting  up,  fhe  may  be  greatly 
relieved,  and  her  pofture  made  as  eafy  as  poflible.  As 
the  chair  runs  upon  caftors,  it  maybe  readily  mov- 
ed, and  by  its  afliftance  the  patient  may  be  enabled 
to  continue  a  long  time  out  of  bed  without  incon- 
venience. 

< 

As  the  invention  is  not  generally  known,  a  draw- 
ing «f  it  may  perhaps  not  be  unacceptable  to  my 
readers.     [Vid.  Plate  I.] 


PLATE 


no  PREVENTION  OF 

PLATE      I. 

\ 
A  perfpeftive  view  of  an   Eafy  Chair,  the  back 

part  let  down  and  the  foot  board  raifed,  which  has 
been  found  very  ufeful  for  lying  in  women  and 
fick  perfons. 

a.  The  back  of  the  Chair, 

b.  The  feat. 

c.  The  foot  board. 

d.  A  fupport  for  the  back  of  the  Chair,  which  is 
only  ufeful  when    the  back   is  let   down,  and 
which  is  fixed  to  the  chair  by  hinges. 

N.  B.  Straps  of  garth  web  on  each  fide  of  the 
Chair  pafs  through  the  arms,  and  are  fixed  to  the 
back  and  foot  board. 


The  breafts  generally  require  great  attention,  ef- 
pecially  during  the  patient's  firft  lying  in.  If  flie 
propofes  to  fuckle  her  child,  it  ought  to  be  laid  to 
them  early,  before  the  milk  can  have  ftagnated  in 
them,  or  they  can  have  acquired  any  great  degree 
of  hardnefs.  It  will  be  beneficial  both  to  the 
mother  and  child,  if  this  be  done  in  a  few  hours 
after  delivery  ;  and  this  is  moft  confiflent  with  the 
operations  of  unaffilted  nature. 

If  the  patient  have  not  fuckled  any  former  child, 
the  infant  will  probably  meet  with  difficulties  in 

fattening 


PUERPERAL  FEVERS,  &c. 

faflening  on  the  nipples.  In  this  cafe  the  breafls 
muft  be  gently  drawn  by  a  fkilful  perfon,  and  if 
her  art  Ihould  fail,  cupping  glaffes  *  of  a  proper 
form  and  fize  Ihould  be  applied,  but  no  violence 
fhould  be  ufed.  Where  the  patient  will  fubmit  to 
this,  and  it  is  done  with  judgment,  except  ths 
breads  have  met  with  accidents,  the  fuccefs  is  al- 
moft  certain. 

To  prevent  the  ftagnation  of  the  milk,  the  breafls 
fhould  be  emptied  four  or  five  times  a  day. 

/ 
If  the  patient's  own  child  cannot  do  this,   fome 

other  infant  fhould  be  applied,  or  we  fhould  have 
recourfe  to  an  able  perfon  well  accuftomed  to  draw 
breafls  J. 

I  am  well  acquainted  with  a  family  fo  dexterous 
in   this  art,   that   an  indurated  gland  or  gathered 
breaft  was  fcarce  ever  known  under  their  manage- 
ment. 

*  **  Papillae,  ex  media  convexitate  mammarum  eminentes,  multum  va- 
riant craflitudine,  &  longitudine  in  diverfis  mulieribus.  Ssepius  contingit, 
ut  a  loricis,  quas  peflimo  more  geftare  coguntur  puellas  fie  deprimantut 
papillae  ut  vix  emineant;  imo  aliquoties  vidi,  fubfediffe  penitus,  ita  ut  loc» 
eminentis  papillae  appareret  foveola  in  mamma  in  qua  delitefceret.  Impoflib- 
ilis  tune  eft  leftatio,  nift  educi  poffet  papilla ;  quod  f«epe  feliciter  obtinetur, 
ft  graviditatis  tempore  facpius  applicetur  parva  cucurbitula,  ex  qua  antlia 
pneumaticae  ope  educitur  aer,  tune  enim  deprefla  papilja  exfurgit,  &  dura 
fjepius  hoc  tentatur  incipit  imminere  magis  magifque-" 

Van  Swiet.  Comment.  Se&.  1338, 

,      £The  eladic  vegetable  bottles  are  not  in  general  fuiEcient  for  this  purpofe, 


112  PREVENTION  OF 

merit.  Their  mode  of  operation  is  fo  very  eafy  as 
to  afford  rather  a  plealing  than  a  painful  fenfation  ; 
and  I  have  been  informed  by  thofe  who  have  ex- 
perienced it,  that  they  could  eafily  fall  afleep  under 
the  operation.  The  method  of  thefe  practitioners 
has  been  kept  a  fecret,  and  as  yet  has  only  been 
tranfmitted  from  the  mother  to  the  daughter.  Hav- 
ing confidered  this  matter  fully  from  comparing 
what  I  have  feen  of  their  practice  with  that  of 
others,  and  from  the  converfation  I  have  had  with 
thofe  who  have  not  only  been  under  their  care,  but 
under  that  too  of  lefs  fkilful  perfons,  I  am  very 
certain  the  whole  art  confifts  in  nothing  more  than 
this  :  the  whole  breaft  and  nipple  being  ftretched 
out,  fo  that  the  breaft  may  affume  a  "conical  form, 
the  tubes  become  perfectly  ftraight  and  open ;  in 
this  lituation  a  hand  being  applied  to  each  fide  of 
the  breaft,  the  milk  is  forced  out  at  the  fame  time 
that  the  perfon's  mouth  is  applied  to  the  nipple.  By 
this  method  a  very  moderate  faction  only  is  re* 
,  quired ;  and  that  violent  degree  of  it  upon  which 
the  generality  of  operators  place  their  depen dance, 
by  which  the  nipple  is  frequently  excoriated,  and 
great  pain  given  to  the  patient  without  her  bread 
being  completely  emptied,  becomes  totally  unnecef. 
fary. 

If  the  breafts  grow  hard  and  knotty  they  fhould 
be  well  rubbed  with  a  fofthand  xnoiftened  with  oil, 

and 


PUERPERAL  FEVERS,  &c.         113 

and  this  operation  fhould  be  repeated  two  or  there 
times  a  day.  In  thefe  cafes  I  have  alfo  applied 
Goulard's  vegeto  mineral  water  with  advantage  *„ 

Thick  rings,  made  of  bees'  wax,  and  fitted  very 
exactly  to  the  nipples,  are  often  preventive  of  fif- 
fures,  by  keeping  the  nipples  elongated,  and  denying 
them  a  liberty  of  mrivelling  up  into  corrugations. 
If  there  be  too  much  milk,  thefe  rings  are  ufeful  in 
caufing  it  to  inn  out ;  but  they  mould  be  made  like 
real  rings,  and  not  like  caps,  as  is  frequently  done 
by  perfons  ignorant  of  the  reafons  for  which  they 
are  ufed,  and  who  imagine  there  is  fome  fpecific 
virtue  in  the  wax  itfelf,  whereas  they  only  aft 
mechanically.  They  mould  be  applied  immediate- 
ly after  the  child  has  finifhed  its  fuclion,  and  be  put 
on  fo  that  the  ends  of  the  nipples  may  protrude 
themfelves  through  them.  Thefe  rings,  however, 
ought  not  to  be  ufed  when  the  milk  runs  out  hi 
too  great  quantities. 

If  fiflures  be  formed,  and  be  attended  with  a  fharp 
acrimonious  humour,  the  acrimony  may  be  greatly 
blunted,  and  the  parts  healed  by  the  application  of 
a  mucilage  compofed  of  gum  arabic  and  a  decoc- 
tion of  cooling  feeds. 

If 

*Vid.  Aikin's  Obfemtions  on  the  external  ufe  of  Preparations  of  Lea«3t 
Part  II,  :'&«$ 

H 


PREVENTION  OF 

If  the  patient  do  not  fuckle  her  child,  no  method 
fhould  be  ufed  either  to  repel  the  milk  or  invite  it 
into  the  breads,  but  it  ftiould  be  left  entirely  to 
nature*;  me  ftiould  live  very  abftemioufly,  little 
or  no  animal  food,  no  ftrong  liquors  mould  be  al- 
lowed her,  and  the  inteftinal  canal  fhould  be  kept 
thoroughly  open. 

Let  the  directions  I  have  given  be  ftri&ly  obferv- 
ed,  and  I  will  venture  to  afTert  that  there  will  be 
neither  puerperal  nor  miliary  fever,  nor  will  the 
milk  fever  be  worth  notice,  except  it  be  her  firfl  ly- 
ing in.  This  may  be  faid  to  be  a  bold  affertion. 
I  am  well  aware  of  the  uncertainty  of  the  medical 
art,  and  of  the  difficulty  of  afcertaining  fa6b,  efpe- 
cially  by  thofe  who,  neglecting  nature  as  their 
guide,  feem  rather  to  take  pleafure  in  ob fl.ru  fting 
her  in  her  operations.  I  know  likewife  the  diffi- 
culty there  is  in  bringing  patients  to  conform  to 
proper  directions,  and  the  flill  greater  one  in  in- 
ducing nurfes,  and  other  attendants,  to  follow  the 
rules  which  are  prefcribed  them. 

I  am  not  now  amufing  the  public  with  idle  theo- 
ries, and  fpeculative  reafonings  ;  I  am  treating  on 
an  affair  of  confequence,  not  only  to  the  female  fex, 
but  to  mankind  in  general.  -I  fpeak  from  fafts, 

from 

*  Thofe  who  wifh  to  fee  this  matter  more  fully  difcuffed,  I  muft  beg  leave 
to  refer  to  my  examination  into  the  propriety  of  drawing  the  breads  of 
thofe  who  do,  and  alfo  of  thofe  who  do  not  give  fuck;  publifhed  alcng  with 
an  inquiry  into  the  nature  and  caufe  of  that  fwelling  in  one  or  both  of  the 
lower  extremities,  which  fometimes  happen*  to  lying  in  women. 


PUERPERAL    FEVERS,    &c.     115 

from  fafts  which  cannot  deceive  me,  founded  upon 
my  Father's  experience  of  more  than  fixty  years, 
and  upon  my  own  of  above  two  thirds  of  that  peri- 
od. I  appeal  to  the  inhabitants  of  this  town 
and  neighbourhood,  where,  if  I  be  guilty  of  mifrep- 
refentation,  I  muft  meet  with  the  imputation  I 
deferve, 

It  would  be  eafy  to  produce  a  long  lift  of  fuc- 
cefsful  cafes ;  fuccefsful  cafes  avail  nothing,  where 
the  unfuccefsful  are  concealed.  It  is  evident  that 
by  much  the  greater  part  of  the  fex  will  do  well,  e- 
ven  under  the  worft  of  treatment.  The  practitioner 
therefore  can  only  judge  from  the  refult  of  general 
practice  ;  and  here,  for  the  fake  of  the  moft  im- 
portant argument  I  can  ufe,  I  am  obliged  to  refer 
to  a  faft,  which  otherwife  could  fcarcebe  mention- 
ed without  a  mew  of  oflentation,  which  I  defpife. 
Out  of  the  whole  number  of  lying  in  patients  whom 
I  have  delivered  (and  I  may  fafely  call  it  a  great 
one)  I  have  never  loft  one,  nor  to  the  beft  of  my 
recollection,  has  one  been  greatly  endangered,  by 
the  puerperal,  miliary,  low  nervous,  putrid  malig- 
nant, or  milk  fever  ;  nor  have  any  of  thefe  fevers 
ended  in  madnefs  *,  or  any  other  difagreeable  com- 
plaint. 

*  "  It  is  not  only  In  lying  in  cafes  that  madnefs  is  fometim.es  in  confe- 
quence  of  the  negleft,  or  ill  treatment  of  this  fever^for,  in  other  perfons  it 
too  often  terminates  in  this  manner.  It  is  therefore  well  worth  obferving, 
fince  experience  confirms  the  faft,  that  this  fort  of  madnefs,  which  follows 
this  low  fever,  will  by  no  means  yield  to  the  common  methods  for  the  cure 

of 

H  a 


PREVENTION    OF 

plaint.  Some  few  indeed  have  had  the  puerperal 
fever,  but  this  has  evidently  arifen  from  nonobferv- 
ance  of  the  rules  above  laid  down.  Some  few  too 
have  had  miliary  eruptions,  proceeding  from  the 
fame  caufe,  though  not  one,  unlefs  my  memory 
greatly  fails  me,  ever  had  what  properly  might  be 
called  a  miliary  fever.  Where  feveriih  fymptoms 
have  appeared  before  delivery,  they  have  been  hap- 
pily extinguiihed.  The  reader  may  perhaps  im- 
agine, that  by  a  different  treatment  diforders  may 
take  different  forms,  and  appear  under  different 
denominations.  That  I  may  not  feem  to  fhelter 
myfelf  under  fo  poor  a  fubterfuge,  I  am  neceflitat- 
ed  to  make  a  farther  declaration.  I  never  loft  a 
patient  either  during  her  month,  or  at  any  other 
time,  where  there  was  the  leaft  reafon  to  imagine 
her  death  was  the  confequence  of  her  lying  in.  It 
muft  however  be  remembered,  that  in  this  lafl  dec- 
laration I  fpeak  only  of  natural  parturitions.  I 
would  by  no  means  be  underftood  to  include  in 
this  account  preternatural  cafes,  or  fuch  labouri- 
ous  ones  as  have  required  the  ufe  of  inflruments  ; 
thofe  of  fl  codings,  or  convulfions,  or  thofe  in  which 
confumptions  have  taken  rife  before  the  patient's 
time  of  delivery.  I  only  mean  likewife  thofe  pa- 
tients whom  I  have  myfelf  attended  during  the 

time 

©f  madnefs,  becaufe  great  evacuations,  as  purging,  vomiting,  and  efpecially 
bkeding,  always  heighten  thedifeafe,  and  foon  either  deftroy  the  patient,  o? 
biing  on  an  incurable  foolilhncfs," 

Etherington  on  Fevers,  p.  -41, 

1  V; 


PUERPERAL   FEVERS,   Sec.     117 

time  of  delivery.  After  fevers  have  been  created  I 
have  been  unfuccefsfully  called  in  to  thofe  deliv- 
ered by  others.  I  have  however  the  pleafure  to  ob- 
ferve,  that  thofe  fevers,  in  this  neighbourhood  at 
leaft,  have  of  late  years  greatly  decreafed.  This 
muft  chiefly  be  attributed  to  a  fyilem  of  manage- 
ment lately  introduced,  much  to  the  honour  of 
our  prefent  practitioners,  and  of  thofe  nurfes  who 
feem  fenfible  of  the  advantages  arifmg  from  it  ; 
and  I  muft  here  do  my  brethren  the  juftice  to  af- 
fert,  that  I  do  not  know  a  place  where  midwifery 
is  more  fuccefsfully  pra6lifed.  Perhaps  fome  gen- 
eral caufe  may  contribute  to  this  fuccefs  amongfl 
the  poor  in  this  town,  viz.  their  eating  very  little 
animal  food,  and  living  chiefly  upon  vegetables. 
Potatoes  are  a  principal  part  of  their  diet,  on  ac- 
count of  their  goodnefs  and  cheapnefs  in  this 
country.  We  have  butter  milk  likewife  in  the 
greateft  perfection,  and  it  is  drank  by  the  common 
people  both  in  ficknefs  and  in  health.  This  liquor 
when  properly  managed  has  a  pleafant  acidity,  and 
very  happily  contributes  to  prevent  and  cure  any 
diforders  arifingfrom  putridity.  In  many  parts  of 
this  kingdom  it  is  fo  ill  prepared,  that  the  poor 
people  will  not  drink  it,  and  it  is  either  thrown  a- 
way  or  given  to  the  fwine.  We  are  likewife  well 
lupplied  with  coals,  which  is  an  article  of  confe- 
quence,  as  fires  prevent  moifture,  and  keep  up  a 
circulation  of  air,  and  there  is  little  danger  of  the 
H  3  poor 


n8  PREVENTION    OF 

poor  people  keeping  fuch  large  fires  as  to  be  over 
heated  by  them.  Does  not  the  pump  water  *  of  this 
place,  by  being  impregnated  with  felenitical  and 
aluminous  falts,  contribute  in  fome  degree  to  pre- 
vent putridity,  whatever  bad  effects  it  may  have  in 
promoting  diibrders  arifmg  from  glandular  ob- 
ftruclions  ?  It  may  be  worthy  of  obfervation,  that 
dyfenteries  are  almoft  unknown  in  this  town. 

Is*  it  not  one  caufe  of  the  frequency  and  fatality 
of  the  puerperal,  jail,  hofpital,  and  other  putrid  fe- 
vers, in  London,  that  fo  many  of  the  inhabitants 
drink,  and  ufe  for  moft  culinary  purpofes,  the 
New  River  water,  which  is  frequently  replete  with 
putrid  vegetable  and  animal  fubftances,  or  the 
Thames  water  t,  Which  is  full  of  all  kinds  of  pu- 
trid matter  ? 


•  •  • 
' 

»• 

*  VicL  Dr.  Percival  on  the  Pump  water  of  Manchester,  Effays  Med,.  and 
Exp.  p.  288. 

I 

T  "  Moft  pump  water  is  as  incapable  of  changing  and  of  being  fpoiled 
by  keeping  as  diftilled  water  ;  for  though  it  be  loaded  with  various  foreign 
particles,  yet  it  feldom  has  any,  or  at  moft  but  a  fmall  proportion  of  a  veg- 
etable, or  animal  nature,  and  therefore  it  will  always  remain  the  fame. 
This  property  of  water  is  not  fo  much  attended  to  as  it  ought  to  be  by  fail- 
ors,  who  ufually  fupply  their  {hips'  with  river  water  taken  up  near  great 
cities,  and  then  keep  it  in  wooden  cafks ;  the  neceffary  confequence  is,  that 
it  foon  putrifies,  and  moft  probably  contributes  very  much  to  the  occafioning 
of  thofc  putrid  difterapers  with  which  failors  are  fo  apt  to  be  afflifted. 
Pump  or  fpring  water  would  be  greatly  preferable,  and  if  they  could  keep 
this  in  glafs  or  ftone  bottles,  or  earthen  jars,  they  would  find  it,  after  being 
carried  round  the  world,  juft  the  fame  as  when  they  fet  out.'"' 

Med.  TxanC,  vol.  j.  p.  19,  by  Dr.  W.  Heberden. 

"Tfce 

. 


PUERPERAL   FEVERS,  &c. 

It  may  feem  ftrange,  but  it  is  neverthelefs  true, 
that  the  puerperal  and  miliary  fevers  are  more  com- 
mon and  more  fatal  in  London  than  in  the  country  ; 
and  yet  it  muft  be  acknowledged  than  in  general 
the  ableft  men  in  every  branch  of  the  profeffion 
refort  to  the  metropolis  :  But  our  wonder  will 
ceafe  when  we  reflect  that  not  only  the  general 
caufes  in  large  populous  towns  will  operate,  but 
likewife  that  the  articles  of  air,  diet,  drefs,  &c.  are 
left  to  the  management  of  the  nurfes  in  that  city, 
who  claim  it  as  a  kind  of  prerogative,  and  it  is 
next  to  facrilege  to  encroach  upon  their  privi- 
leges. Whether  this  circumftance  has  been  con- 
fidered  in  the  important  light  it  deferves,  or  wheth* 
cr  the  fuccefs  of  a  reformation  has  been  defpaired 
of,  I  will  not  pretend  to  determine.  The  nurfes 
in  London  are  a  numerous  and  powerful  body,  and 
an  attempt  to  reform  their  ancient  cuftoms  might 

be 

"  The  great  tendency  in  the  Thames  water  firfl  to  ferment,  and  then  to 
become  pure,  in  long  voyages  is  well  known,  and  it  is  probable  that  this 
quality  is  owing  to  the  extraordinary  quantity  of  putrid  matter  with  which 
it  is  impregnated  at  the  place  where  it  rs  taken  up,  viz,  a  little  below  Lon- 
don bridge," 

PringleY  Appendix,  p.  67. 

Sir  John  Pringle  in  his  Obfervations  on  the  Dyfentery  fays,  "  Having 
obferved  in  my  private  pra&ice  that  fome  were  better  for  drinking  Briftol 
water,  not  only  at  the  fpring,  but  at  a  diftance,  I  defired  one  of  my  patients 
(who  had  come  from  the  Havannah)  to  obferve  whether  he  found  any  differ- 
ence between  drinking  the  river  water  and  the  pump  water  in  this  city ;  and 
after  fome  trials  he  affured  me  that  he  was  lefs  liable  to  a  return  of  his  flux 

ufed  the  latter," 

Obf.  on  the  Difeafes  of  the  Army.  p. 

H4 


120  PREVENTION    OF 

be  looked  upon  as  an  open  attack  upon  them,  a  vi- 
olation of  their  rights,  and  an  adual  declaration  of 
war.  A  young  man  juft  coming  into  bufmefs 
might  juftly  think  it  too  daring  an  attempt  to  en- 
counter  them  ;  he  would  in  all  probability  be  une- 
qual to  the  tafk,  and  his  future  progrefs  would  be 
ilopt,  by  making  fuch  powerful  enemies.  The 
man  in  full  and  eflablifhed  bufmefs  could  not  per- 
haps fpare  fo  much  time  as  would  be  necelfary,  for  it 
would  require  a  very  frequent  and  conftant  attend- 
ance upon  his  patients  to  fee  that  the  nurfes  did 
their  duty  ;  and  by  fuch  an  attempt  he  might  lofe 
much,  and  gain  little,  except  trouble  and  oppofi- 
tion. 

But  the  fatality  of  thefe  fevers  is  not  confined  to 
tke  metropolis.  There  are  feveral  country  towns 
where  puerperal  fevers  are  very  fatal,  particularly 
the  town  of  Northampton,  a  place  otherwife  re- 
markable for  its  healthfulnefs,  and  fituated  in  an 
open,  champaign  country  ;  and  I  am  acquainted 
with  two  gentlemen  in  another  town,  where  the 
whole  bufmefs  of  midwifery  is  divided  betwixt 
them,  and  it  is  very  remarkable  that  one  of  them 
lofesYeveral  patients  every  year  of  the  puerperal  fe- 
ver, and  the  other  never  fo  much  as  meets  with  the 
diforder  :  but  their  methods  of  treating  their  pa- 
tients, as  J  am  informed,  are  very  different. 

From 


PUERPERAL   FEVERS,    &c.     121 

From  what  has  been  above  remarked,  I  imagine 
it  will  appear  that  where  a  due  obfervance  is  paid 
to  nature,  not  only  during  labour,  but  for  fome 
time  afterwards,  there  is  not  the  leaft  danger  to  be 
apprehended  from  natural  parturitions  ;  that  moft, 
if  not  all  of  thofe  diforders  which  are  ufually  fu-p- 
pofed  to  be  peculiarly  incident  to  the  puerperal 
Hate,  are  either  the  effe&s  of  mifmanagement  in 
the  accoucheur  ornurfes,  or  elfearife  from  the  pa- 
tient's own  imprudence  ;  that  they  may  in  general 
be  truly  faid  to  be  fabricated,  and  may  always,  ex- 
cept in  lying  in  hofpitals,  be  avoided. 

In  hofpitals  indeed,  where  numbers  are  crowd- 
ed together,  not  only  in  the  fame  houfe,  but  in 
the  fame  ward,  the  puerperal  fever  *  cannot  fo  ea- 
fily  be  prevented,  though  the  miliary  fever  un- 
doubtedly may. 

A 

*  Van  Swieten,  in  his  Commentaries  upon  Boerhaave's  Aphorifms,  Seft. 
S33r>  gives  the  following  quotation  from  Feu.  «  Obfervatafideliaconfirm- 
averunt,  putrida  haec  miafmata  nocuifle  puerperis,  dum  in  nofocomiis  de- 
cumbebant  :  Magnus  enim  illarum  numerus  peribat ;  &  fufpicari  ceperant 
nofdcomii  prsefecli,  ignorantiam  aut  negligentiam  obftelricandum  in  caufa 
effe.  Plura  fecabantur  cadavera  defun&arum,  &  corporis  interiora  abfcefli- 
bus  plena  fuerunt  inventa.  Sapiens  medicus,  omnia  attente  examinans,  hanc 
caufam  invenit,  quod  fub  conclavi  puerperarum.  decumberent  vulnerati. 
Confirmabattir  ejus  fentcntia  inde  imprimis,  quod  au&o  vulneratovum  de- 
cumbentium  numero  crefceret  puerperarum  ftrages,  minuto  pariter  decrefce- 
rct.  Aer  humidus,  tam  calidus,  quam  frigidus  nocebat ;  ficcus  autem  prode- 
rat  :  Notum  enim  eft,  humidum  aerem  putredini  favere,  praecipue  fi  fimul 
calidus  fuerit.  Dum  autem  puerperae  locabantur  in  conclavi  inferiori,  non 
obfervabatur  amplius  haec  ftrages  :  A.cr  enim,  putridis  exhalationibus  imbu~ 

tus,  levior  eft,  unde  fuperiora  petit." 

Feu  le  pra^iq.  des  accouch.  p.  ^65. 


iss  PREVENTION    OF 

A  Gentleman  whofe  veracity  I  can  depend  on,  in- 
forms me  that  he  attended  a  fmall  private  lying  in 
hofpital  in  London,  in  the  latter  end  of  May, 
June,  and  the  beginning  of  July,  1761  ;  during 
which  time  the  puerperal  fever  was  very  fatal  there ; 
that  to  the  beft  of  his  recolle&ion  they  loft  about 
twenty  patients  in  the  month  of  June  ;  that  during 
this  month  he  himfelf  delivered  fix  women  in  a 
Ihort  time  in  the  hofpital  of  natural  births,  and 
they  all  died  :  He  was  fo  mocked  with  the  lofs,  that 
he  defired  the  gentleman  who  had  the  care  of  the 
hofpital  to  deliver  fome  of  thofe  who  mould  next 
be  in  labour,  which  he  did,  but  they  met  with  no 
better  fate.  They  buried  two  women  in  one  coffin 
to  conceal  their  bad  fuccefs.  Several  gentlemen 
of  the  faculty  were  invited  to  the  hofpital  to  in- 
quire into  the  caufe  of  this  great  fatality  ;  but  I 
could  not  learn  that  they  were  able  to  account  for 
it  in  a  fatisfa&ory  manner*. 

Buildings  might  be  raifed  on  purpofe  for  the 
reception  of  lying  in  women,  and  fo  contrived  that 

the 

*  The  following  paffage  from  Mr.  Doulcet's  memoir  before  mentioned, 
is  a  further  confirmation  of  the  opinion  I  have  advanced,  "  The  memoir 
te  upon  which  the  Royal  Medical  Society  has  been  confultedby  government, 
"  and  of  which  we  are  now  ordered  to  give  an  account,  contains  the  defcrip- 
"  tion  and  treatment  of  a  difeafe  which  has  attacked  lying  in  women  at  the 
"  Hotel  Dieu  at  Paris  ;  and  which  has  made  its  appearance  in  that  hofpital 
*' at  different  times,  but  more  frequently  than  ever  fmce  the  year  1774. 
"  The  late  Mr.  Doulcet  found  a  method  of  curing  this  difeafe,  extremely 
"  fimple,  and  which  has  never  yet  failed  of  fuccefs  fmce  it  has  been  employ- 
"  ed;  although  before  this  method  was  made  ufe  of,  the  difeafe  had  always 
*'  been  fatal  to  every  woman  who  was  attacked  with  it  in  that  hofpital," 


. 

PUERPERAL  FEVERS,  Sec.  123 
the  air  might  be  kept  in  conftant  circulation,  in 
fuch  a  manner  that  there  would  be  no  danger 
either  of  the  creation  or  communication  of  this  dif- 
order.  The  expenfe  of  fuch  edifices  would  be 
rather  greater  than  ufual.  The  rooms  muft  be 
lofty,  open  galleries  with  unglazed  windows  mould 
run  through  the  whole  buildings.  The  wards 
mould  be  all  upon  the  centre  floors,  and  they 
mould  have  no  doors  except  into  the  galleries,  and 
thofe  doors  mould  be  oppofite  to  the  windows  in 
the  wards,  that  there  may  be  a  thorough  ventila- 
tion of  air  when  the  windows  are  opened.  In  the 
upper  part  of  the  doors  mould  be  feveral  holes  to 
let  out  the  foul  air. 

The  ground  plans  mould  ferve  for  offices,  and 
the  upper  {lories  be  converted  into  lodging  rooms 
for  nurfes  and  fervants.  An  entire  apartment 
ihould  be  allotted  to  every  patient,  or  elfe  if  large 
wards  were  conftrufted  the  windows  mould  be 
placed  very  high,  with  the  uppermofl  fames  made 
to  let  down.  Large  apertures  mould  be  made  as 
high  as  poilible  in  the  partition  wall  which  divides 
the  walls  from  the  gallery,  after  the  manner  of  the 
Leicefter  infirmary  ;  and  in  the  upper  partoffome 
of  the  windows  the  fartheft  from  the  fire  mould  be 
fixed  a  few  leaden  lattices  to  admit  frefh  air,  or 
what  is  ftill  better  circular,  or,  as  they  are  called 
by  fome,  ^Eolian  ventilators,  I  do  not  fuppofe 

that 


124  PREVENTION   OP 

that  the  fuperior  advantages  of  thefe  ventilators 
Over  a  leaden  lattice  conlifts  in  admitting  more 
frefh,  or  extracting  more  foul  air  ;  but  by  their 
circulatory  motion  they  prevent  the  air  from  rum- 
ing  dire&ly  upon  the  perfons  in  the  room,  and 
thereby  giving  them  cold.  Thefe  mould  be  kept 
open  night  and  day,  that  a  conftant  circulation  of 
air  may  be  maintained  :  For  it  will  not  be  fuffi- 
cient  if  a  door,  or  even  a  window  is  opened  a  lit- 
tle in  the  middle  of  the  day  only,  of  which, who- 
ever will  take  the  trouble  to  go  into  the  ward  of  an 
hofpital  early  in  a  morning  will  thoroughly  be 
convinced,  the  air  having  been  rendered  fo  foul 
and  difagreeable  by  a  number  of  people  breathing 
in  it  the  whole  night,  as  to  make  the  atmofphere 
very  unwholefome,  not  only  to  lying  in  women, 
but  to  any  other  perfon. 

Several  air  pipes  made  of  wood  of  about  fix  in- 
ches diameter  fixed  in  every  ward,  and  paffing 
through  the  cieling  and  roof,  have  been  found  very 
ufeful  in  the  Manchefler  infirmary.  I  have  been  in 
a  great  number  of  hofpitals,  but  I  do  not  know  any 
fo  free  from  foul  air  as  that  infirmary,  which  may, 
I  think,  be  eafily  accounted  for.  It  is  fituated  up- 
on the  higheft  point  of  ground  about  the  town  ;  the 
building  is  long  and  narrow,  having  no  inner 
courts  ;  the  principal  wards  are  fifteen  feet  high, 
and  the  largeft  of  them  do  not  contain  more  than 

thirteen 


PUERPERAL   FEVERS,    Sac.      125 

thirteen  beds.  A  large  gallery  runs  through  the 
whole  length  of  the  houfe,  and  that  is  interfered 
by  the  chapel  and  the  great  ftair  cafe  which  lie 
open  to  it  ;  in  thefe  are  windows,  eaft,  weft,  north, 
and  fouth,  which  are  fet  open  every  day  as  often 
as  the  weather  permits.  In  the  galleries,  and  in 
many  of  the  wards  lead  lattices  are  fixed  in  the 
windows.  Holes  are  cut  in  the  upper  part  of  the 
doors,  and  the  doors  are  generally  open  in  the  day 
time.  In  the  largeft  wards  are  openings  in  the 
wall  likewife  to  admit  frefh  air. 

As  a  proof  of  the  advantages  of  an  hofpital  well 
ventilated,  it  may  not  be  amifs  to  compare  the  fuc- 
cefs  attending  it,  with  that  of  a  fmall  crowded 
houfe,  hired  for  the  reception  of  patients  at  the 
fir  ft  inftitution  of  this  chanty,  before  a  proper 
building  could  be  got  ready. 

In  the  fmall  houfe  403  patients  were  admitted 
in  the  fpace  of  three  years,  out  of  that  number  22 
died  in  the  houfe,  which  is  about  the  proportion  of 
one  in  i8y.  In  the  prefent  infirmary  between  the 
2^th  of  June,  1755,  and  the  24th  of  June,  1771, 
6459  *n  patients  were  admitted  ;  out  of  that  num- 
ber 263  died  in  the  houfe,  which  is  nearly  one  in 
24  j.  This  difference  of  fuccefs  muft,  I  think,  be 
principally  owing  to  the  plenty  of  room  and  free 
ventilation,  for  the  perfons  concerned  when"  this 

chanty 


126  PREVENTION   OF 

charity  was  in  its  infancy,  were  more  careful  both 
in  regard  to  the  admiflion  and  difcharge  of  patients 
than  they  have  fince  been,  left  a  long  lift  of  deaths 
Ihould  have  brought  the  infant  charity  into  difre- 
pute.  Poflibly  it  may  be  urged  as  an  objection  to 
thefe  calculations,  that  many  of  thefe  in  patients 
were  difcharged,  or  made  out  patients  at  a  time 
when  there  were  little  expectations  of  their  recov- 
ery ;  which  is  certainly  very  true  :  But  in  anfwer 
to  this,  it  muft  be  remembered  likewife,  that  as  all 
accidents  are  admitted  without  referve,  many  are 
taken  into  the  houfe  in  a  dying  condition,  and 
feveral  have  died  before  any  means  could  be  ufed 
for  their  relief  ;  and  the  calculations  of  thofe  who 
died  in  the  former,  and  in  the  prefent  infirmary 
were  made  by  the  fame  rule,  therefore  the  objec- 
tion, if  it  be  one,  lies  equally  againft  both. 

Befides  air  pipes  carried  through  the  roof,  others 
may  be  let  into  the  chimney  of  the  ward  above,  as 
has  been  praftifed  in  St.  George's  hofpitaL* 

Moifture 

*  "  In  wards  which  are  clofe  it  nas  been  found  that  one  or  two  fquare 
lioles  of  about  fix  or  eight  inches  diameter,  cut  in  the  ceiling,  and  a  tube 
•mede  of  wood  fitted  to  it,  and  carried  up  into  the  chimney  of  the  ward 
•above,  fo  as  to  enter  above  the  grate,  is  one  of  the  beft  contrivances  for 
procuring  a  free  circulation  of  air,  as  the  foul  air,  which  is  lighteft,  and  oc- 
cupies the  higheft  part  of  the  ward,  finds  a  free  exit  by  thefe  tubes.  We 
lave  fuch  tubes  now  fixed  at  St.  George's  hofpital.  A  hole  cut  above  the 
tloor  of  the  ward,  or  in  the  upper  part  of  the  windows,  and  one  of  what  are 
called  chamber  ventilators,  fixed  in  it,  will  anfwer,  where  holes  cannot  be 
conveniently  cut  in  the  cieling." 

Monro  on  the  Dif-  of  Military  Hofpitals,  p.  368. 


PUERPERAL   FEVERS,   &c.     127 

Moifture  *  is  more  to  be  guarded  againft  than 
cold.      Dr.  Lind  obferved  that   new    Ihips  were 
.  more  unhealthy  than  old  ones,  owing  to  the  moift 
exhalations  from  the  wood. 

I  am  afraid  no  methods  will  be  effectual  where 
feveral  lying  in  women  are  in  one  ward.  It  will 
be  very  difficult  to  keep  the  air  pure,  dry,  and 
fweet,  and  at  the  fame  time  to  accommodate  the 
heat  of  the  ward  to  their  different  conflitutions  and 
fymptoms.  If  feparate  apartments  cannot  be  al- 
lowed to  every  patient,  at  leaft  as'foon  as  the  fever 
has  feized  one,  fhe  ought  immediately  to  be  mov- 
ed into  another  room,  not  only  for  her  immediate 
fafety,  but  for  that  of  the  other  patients.  Or  it 
would  be  ftill  better  if  every  woman  was  delivered 
in  a  feparate  ward,  and  was  to  remain  there  for  a 
week  or  ten  days,  till  all  danger  of  this  fever 
was  over. 

I 

*  "  Heat  and  moifture  become,  when  joined,  the  parents  of  putrefaction; 
to  which  if  we  add  imprifoned  animal  fteams,  we  perhaps  form  no  imper- 
feft  idea  of  the  efficient  caufe  of  that  ficknefs,  which  generally  prevails  in 
large  new  built  {hips  :  And  however  fimple  the  inveftigation  may  be,  the 
analogy  it  bears  (the  aggravating  circumftance  of  difeafed  perfpiration  ex- 
cepted)  to  all  experienced  fickly  climates,  feems  abundantly  to  confirm  the 
folution.  Thofe  who  have  feen  the  effefts  of  unfeafoned  timber  on  board, 
will  not  think  the  quantity  of  vapour  arifing  from  the  fappy  wood  trifling  or 
innoxious.  Thus,  efpecially  during  the  night,  we,  as  it  were  realife  the 
baneful  dews  of  the  torrid  and  other  indifpofing  climates,  and  create  that 
very  conftitution  of  air,  whofe  confequent  difeafes  prove  fo  often  fatal  to 
our  fleets," 

Lind  on  the  Health  of  Seamen,  p.  77. 


PREVENTION    OF 

I  am  not  ignorant  of  the  ufe  of  Hales's  and 
Pringle's  ventilators,  which  are  exceedingly  prop- 
er, and  fhould,  together  with  every  other  afliftance 
for  clearing  the  wards  of  foul  air,  be  made  ufe  of; 
but  the  beft  of  them  alone  is  not  to  be  depended 
upon.  I  have  frequently  been  in  an  hofpital,  in 
which,  notwithflanding  there  is  an  extremely  good 
ventilator,  the  air  is  foul  and  difagreeable,  and 
the  houfe  is  fcarcely  ever  free  from  the  hofpital 
fever.  In  this  hofpital,  compound  fractures,  and 
fractures  of  the  Ikull,  though  under  the  care  of  the 
ableft  furgeons,  are  feldom  fuccefsfully  treated. 

In  lying  in  hofpitals,  and  I  may  add  in  every 
hofpital,  the  bed  flocks  mould  be  of  iron.  [Vid. 
Plate  II.] 


PLATE 


PUERPERAL  FEVERS,  &c.     129 

PLATE        II. 

Fig.  1.  A  perfpeftive  view  of  an  Iron  Bedftead 
made  at  Birmingham,  the  invention  of  Do&or 
Vaughan,  an  ingenious  Phyfician  at  Leicefter. 
It  ferves  every  purpofe  of  a  bed  chair  or  dozer. 
The  patient  may  be  raifed  and  lowered  in  it  to 
any  pitch,  with  lefs  fatigue  than  that  which 
ufually  arifes  from  other  methods  ;  it  is  there- 
fore of  great  utility  to  fick  perfons  aud  lying  in 
women. 

a.  b.  The  upper  part  of  it,  moving  upon  the 
hinge  (a)  to  correfpond  with  which  there  is  an* 
other  hinge  upon  the  other  fide  of  the  bed. 

c.  A  rack  wheel,  which  is  alfo  anfwered  by  an- 
other  on  the  other  fide. 

d.  The  handle  which  gives  motion  to  the  arbor, 
pinions,  and  click  wheel. 

e.  The  click  wheel. 

f.  The  click* 

Fig.  2.  The  plan  of  the  bedftead. 

d.  The  handle. 

e.  The  click  wheel,  fattened  to  the  pinion. 

g.g.  Pinions  of  twelve  teeth  each  entering  between 
the  teeth  of  the  rack  wheels  which  are  connected 
by  an  arbor  from  g.  to  g, 

•:• 
T..^ 

Mr.  Alexander  Brodie,  Whitefmith,  near  Tem- 
ple Bar,  has  obtained  a  patient  for  a  contrivance 
I  fomething 


130  PREVENTION  OF 

fomething  fimilar  to  this,  which  he  calls  his  new- 
invented  Bedfcrew  Lever,  calculated  for  the  eafe 
of  fick  and  gouty  people,  or  childbed  women  ; 
which  raifes  them  from  a  lying  to  a  fitting  pofcure, 
and  lowers  them  again  fo  gently  as  hardly  to  be 
felt.  His  Lever,  he  informs  me,  is  moved  by  a 
fcrew  fixed  at  the  foot  of  the  bed. 

Whenever  the  patient  has  recovered  from  this 
fever  and  is  removed  into  another  room,  the  bed- 
ding and  curtains  mould  be  warned,  the  floor  and 
wood  work  mould  be  cleanfed  with  vinegar,  and 
it  would  ftill  add  to  the  falubrity  of  the  apart- 
ment, if  it  were  floved  with  brimflone,  or  what  is 
much  more  effectual,  if  explofions  of  fmall  quan- 
tities of  gunpowder  were  made  in  it  after  the  man- 
ner defcribed  by  Doftor  Lind,  which  driving  out 
the  foul  air,  a  frefh  current  immediately  rufhes  in 
to  fill  up  the  void  fpace  occafioned  by  the  explofion. 
The  Do&or  feems  to  think  that  the  good  effects 
of  it  in  purifying  mips,  or  other  infefted  places,  is 
owing  to  the  antifeptic  vapour  ari  ling  from  it;  but, 
£  Is  it  not  more  probably  owing  to  the  explofion  ? 
He  fays  he  has  found  this  method  effectual  in 
purifying  the  air,  and  that  it  is  inoffenfive  to  the 
lungs.  The  fleams  of  warm  vinegar  applied  to 
the  patient's  noftrils  are  very  refreihing ;  but  fumi- 
gating the  wards  with  it,  as  has  been  advifed  by 
many  authors,  has  not,  I  believe,  proved  fo  anti- 
feptic 


PUERPERAL    FEVERS,  <&c. 

feptic  as  was  at  firft  imagined  ;  which  may  be  ow- 
ing probably  to  the  following  caufe  : 

In  diflilling  vinegar  it  is  very  well  known  that 
what  comes  over  at  firft  is  moftly  water,  to  the 
amount  of  a  third  or  fourth  of  the  whole  qpanti- 
ty  ;  this  is  generally  thrown  away  as  ufelefs,  and 
the  very  acid  parts  which  are  fuppofed  to  be  pro- 
ductive of  the  greateft  good,  are  not  to  be  railed 
without  a  very  confiderable  degree  of  heat.  So 
much  watery  fteam  therefore  being  diffufed  all 
over  the  room,  may  tend  to  increafe  thofe  com- 
plaints it  was  defigned  to  remedy  ;  for  it  is  univer- 
faliy  allowed  that  heat  and  moifture  when  joined 
are  the  parents  of  putrefaction. 


I  have  my  doubts   in  regard  to  the  utility  o£ 
dry   or  moifl  fumes*,   or  fprinklings   in  general > 

fuch 

*  Doflie,  fpeaking  of  the  Murrain,  fays,  "But  thefe  fumigations,  fre- 
quently repeated  as  they  were  for  this  purpofe,  in  clofe  places  where  the 
beafls  were  confined,  were  not  only  ineffectual  to  that  purpofe,  but  noxious 
in  a  confiderable  degree,  as  being  very  conducive  to  the  prevalence  of  the 
contagion.  For  being  in  general  made  with  bodies  that  afforded  an  acrid 
fteam,  fuch  as  fulphur,  vinegar,  tobacco,  or  terebinthinate  fubftances,  they 
injured  the  refpiration  of  the  beafts,  and  thence  diminifhirig  the  animal 
ftrength,  rendered  them  more  difpofed  to  be  affefted  by  the  contagion.  A 
multiplicity  of  fa£ls  confirm  the  truth  of  this  remark,  as  it  appears  frorri 
nearly  all  the  accounts  given,  that  the  greater  number  of  beafts  have  been 
loft  where  means  of  this  kind  have  been  rnoft  employed,  The  medicating 
the  cattle  externally,  by  rubbing  them  with  fulphur,  gunpowder,  tobacco 
water,  and  other  fubftances,  do  lefs  harm  than  the  fumigations,  but  not 
inore  good?  as  experience  has  largely  evinced* 

"A 

1  a 


i32  PREVENTION   OF 

fuch  as  camphorated  vinegar,  tobacco,  nitre,  pitch, 
tar,  refinous  or  aromatic  gums,  fulphur,  or  frank- 
incenfe,  during  the  patient's  flay  in  the  room. 
Without  the  free  admiflion  of  air  I  am  apprehen- 
five  they  will  operate  to  no  good  purpofe.  If  a 
fufficient  quantity  of  free  air  be  admitted  they 
will  feldom  be  neceffary.  And  if  by  their  means 
the  air  is  eifher  heated  or  moiftened,  they  will 
certainly  be  prejudicial  :  But  a!l  thefe  methods 
may  be  ufed  with  advantage  if  there  be  no  patient 
in  the  room. 


If  the  lungs  be  inflamed,  or  the  patient  have  any 
difficulty  in  breathing,  the  receiving  fuch  acrid 
fleams  or  fumes  into  the  lungs  would  certainly  be 
of  bad  eonfequence. 


*<  A  free  refpiration  of  undepraved  air  is  effentially  neceflary  to  the  ftrength- 
of  the  beafts,  in  order  to  their  refitting  the  effects  of  the  contagion.  It  has 
appeared  from  a  number  of  obfervations  which  are  recorded  by  the  writers- 
on  this  fubjeft,  that  the  cattle  which  have  been  kept  out  in  the  air,  when  the- 
•weather  was  not  inclement  through  too  much  cold  or  moifture,  have  been 
lefs  fubje£t  to  take  this  infection,  and  recovered  in  greater  numbers  when 
feized  with  it,  than  thofe  which  were  houfed.  In  Denmark  during  the  ter- 
rible vifitation  mentioned  above  of  this  difeafe  in  the  year  1 759,  many  of 
the  boors  attempted  to  preferve  their  cattle  from  the  infection  by  the  fumes 
of  tobacco,  which  they  continually  fmoked  in  the  cow  houfe,  even  fitting, 
up  the  whole  night  in  turns  for  that  purpofe  in  the  midft  of  them.  But  it 
was  remarked  that  fcarcely  any  of  the  cattle  Co  treated  avoided  the  contagioa 
and  death  in  conference  of  it." 

M-emoirs  of  Agriculture,  p,  $89. 


PUERPERAL   FEVERS,    &c.     133 

In  puerperal  women  perfumes*  have  been 
known  to  bring  on  dangerous  fymptoms,  and  I 
am  afraid  that  all  thefe  methods  can  only  tend  to 
deceive  by  concealing,  inftead  of  correcting  the 
vitiated  air. 

Heat,  moifture,  ftagnated  air,  and  human  efflu- 
via, fuch  as  fweat  and  the  perfpiratory  matter  from 
the  lungs  and  the  (kin,  &c.  are  the  grand  promot- 
ers of  putrefaclion  ;  without  thefe  obftacles  can  be 
removed,  every  attempt  to  corre£fc  the  vitiated  air 
will  not,  I  am  afraid,  avail.  A  probable  method 
is  propofed  by  Dr.  Alexander  t  of  placing  large 

quantities 

*  *c  Fragrantes  odores,  quibus  multi  adeo  abut  folent,  ut  etiam  mutatis 
veftibus  tota  cutis  illis  imbuta  maneat,  turbant  fajpe  adeo  puerperas  ut  mox 
fequantur  enormes  capitis  dolores,  dcliria  lochiorum  fuppreflio." 

Van  Swieten.  Comment.  Sect.  1331. 

-r  Alexander  fpeaking  of  putrid  diftempers,  fays,  "  As  the  breathing  of 
cool  freih  air  feems  above  all  other  things  a  fine  qua  mm,  directions  to  fupply 
tlie  patient  plentifully  with  it  can  never  be  too  frequently,  or  too  ftrongly 
inculcated  :  Where  this  is  impoflible  to  be  done,  as  in  jails,  the  holds  of 
fliips,  &c.  every  method  we  arc  capable  of  mentioning  (hould  be  tried  to 
correct  and  deftroy  the  virulence  of  thefe  putrid  particles,  -which  cannot 
poflibly  be  diflodged.  Authors  have  from  time  to  time  contrived  a  variety 
of  things  for  this  valuable  purpofe  ;  fuch  as  burning  aromatics  in,  or  fprink- 
ling  the  room  with  them,  warning  the  room  with  vinegar,  with  fpirits,  &c. 
It  does  not  appear  however  upon  the  ftrifteft  inquiry,  that  thefe  method* 
have  been  attended  with  any  remarkable,  nor  indeed  with  any  vilible  fuc- 
cefs.  Their  intention  indeed  is  certainly  a  very  rational  one,  viz.  to  im-* 
pregnate  the  whole  air  of  a  room  with  antifeptic  matter,  in  fuch  a  manner 
that  the  patient  may  draw  a  good  deal  of  it  into  his  lungs,  at  every  infpira- 
iu>n,  But  as  their  having  hitherto  done  fo  liiue  good?  gives  ground  for  a 

fufpicion 

13 


134  PREVENTION    OF 

quantities  of  fermenting  antifeptic  mixtures  in 
different  parts  of  the  room.  In  putrid  fevers,  and 
in  the  putrid  fore  throat  I  have  frequently  advifed 
patients  to  breathe  the  fixed  air  arifing  from  ef- 
fervefcent  mixtures.  In  feveral  the  ufe  of  it  was 
attended  with  manifeft  advantages  ;  nor  did  the 
leaft  inconvenience  accrue  to  any,  though  fome  of 
them  were  very  tender  people,  and  had  weak  lungs, 
and  one  in  particular  was  a  young  lady  who  had  a 
putrid  fore  throat,  and  had  been  fubjeft  to  a  cough 
and  fpitting  of  blood,  and  no  other  remedy  was 
made  ufe  of,  except  gentle  vomits,  fait  of  worm- 
wood and  juice  of  lemons  taken  into  the  ftomach 

during 

fufpicion  that  they  have  either  in  this  way  not  been  intimately  enough 
blended  with  the  air,  or  not  blended  with  it  in  a  fufficient  quantity,  I  think, 
other  methods  ought  to  have  a  fair  trial  alfo,  efpecially  as  there  feem  to  be 
others  better  calculated  for  reruLering  any  antifeptic  matter  more  light  and 
fupportable  by,  and  more  diffufible  through  the  air  of  a  room. 

«  It  was  obferved  before  towards  the  beginning  of  this  Effay,  that  Dr, 
Macbride  had  fweqtened  feveral  pieces  of  putrid  meat  by  fufpending  them 
in  the  fleams  arifang  from  fermenting  antifeptics  ;  and  this  me  thinks  fur- 
aifhes  us  with  a  hint  how  to  endeavour  to  correcl  the  air  of  a  confined  place, 
and  render  it  antifeptic,  where  patients  with  putrid  difeafes  are  ;  which  is 
by  placing  large  quantities  of  fermenting  antifeptic  mixtures  in  different 
parts  of  it.  If  this  expedient  fhould  not  be  found  to  anfwer,  a  ftill  farther 
trial  may  be  made.  Let  a  large  quantity  of  a  deco&ion  of  bark,  camomile 
Cowers,  &c.  when  in  the  aft  of  fermentation,  into  which  it  may  be  eafily 
brought,  be  put  by  the  patient's  bed  fide,  and  his  head  fupported  over  it, 
fo  as  to  breathe  the  fleam  as  often,  and  as  long  at  a  time  as  can  be  done. 
Should  this  method  produce  any  good  effect,  it  might  very  eafily  be  improv- 
ed by  means  of  a  machine  contrived  to  convey  the  greateft  part  of  the  fleam 
jirifing  from  fuch  a  mixture,  into  the  patient's  lungs." 

Experimental  Effays,  p.  66, 


PUERPERAL  FEVERS,  &c.     135 

during  the  aft  of  effervefcence,  and  antifeptic  gar- 
gles. I  have  likewife  ufed  it  with  advantage  ex- 
ternally in  putrid  ulcers,  by  receiving  the  fixed  air 
arifing  from  fuch  effervefcing  mixtures  upon  the 
affected  part. 

Notwithstanding  what  I  have  advanced  for  the 
neceflity  of  free  air,  and  the  cool  regimen,  yet  I 
muft  caution  the  young  practitioner  againft  expof- 
ing  his  patients  too  fuddenly  to  the  cold  air,  after 
being  much  heated,  which  would  be  apt  to  caufe 
obftru&ions  and  fevers  ;  and  although  great  ad- 
vantages have  accrued  from  the  ufe  of  acids,  acef- 
ent  liquors,  and  fruits,  yet  il;  muft  be  obferved  that 
they  ought  not  to  be  ufed  where  the  bile  is  defi- 
cient, either  in  quantity  or  quality,  where  an  acid 
acrimony  abounds  in  the  privies  vice,  or  where  the 
patients  have  found  by  experience,  that  they  difa- 
gree*. 

*  I  muft  refer  thofe  who  would  choofe  to  fee  the  affair  of  hofpitats  fur- 
ther difcuffed,  to  a  very  ferifible  pamphlet  lately  publifhed  by  my  worthy- 
friend  Dr.  Aikin,  entitled.  Thoughts  on  Hofpitals. 


I  4  C  H  A  P, 


CURE       OF      THE 


CHAP.        VII. 


OF  THE  CURE  or  THE  PUERPERAL  FEVER. 


HENEVER  a  lying  in  woman 
is  feized  with  a  rigour  or  cold 
fhivering,  fucceeded  by  a  hot 
burning  fit,  and  terminating  in 
jaJWeat,  we  mould  be  very  at- 
tentive to  her,  as  much  depends 
upon  the  management  of  the  patient,  during  the 
continuance  of  thefe  fymptoms  ;  for  by  a  proper 
treatment  the  diforder  may  frequently  be  flopped 
in  its  firft  ftage.  and  farther  mifchief  prevented. 
I  do  not  apprehend  the  cold  fit  to  be  of  the  danger- 
ous confequence  ufually  imagined.  I  never  knew 
it  fatal*,  and  thofe  authors  who  have  mentioned  it 


as 


*  *'  I  never  faw  a  pcrfon  die  in  a  cold  fit  (fpeaking  of  the  ague)  but  have 
known  feveral  carried  off  in  the  hot  one  by  ftrong  convulfions,  or  delirium 
and  other  fyrnptoms,  I  am  clearly  of  opinion  that  it  is  the  hot  fit,  or  fever, 


PUERPERAL    FEVER.        137 

as  fuch,  have  not,  I  believe,  fpoken  from  fa£h 
falling  under  their  own  infpeftion.  If  it  have  ever 
proved  fo,  it  muft  have  been  under  very  extraor- 
dinary circumftances.  We  need  not  particularly 
guard  againft  this  fymptom  by  two  warm  a  regi- 
men, much  lefs  need  we  do  any  thing  when  it  is 
actually  exifting  that  may  be  of  pernicious  confe- 
quence  in  the  future  progrefs  of  the  fever  •  and 
though  the  patient  according  to  her  own  fenfations 
be  colder  than  in  health,  yet  fhe  is  feldom  in  real* 
ity  fo.  For  by  feveral  experiments  made  by  *  Dr. 
Home  in  the  cold,  and  even  Ihivering  fit  of  an  in- 
termittent, it  appeared  that  the  heat  of  the  patient 
by  Fahrenheit's  thermometers  was  104  degrees, 
whereas  that  of  a  perfon  in  health  feldom  exceeds 
98  f .  In  fome  agues  the  thermometer  applied  to 
the  patient's  body  finks  below  the  ftarndard,  as  was 
found  in  the  Edinburgh  infirmary,  but  this  hap- 
pens in  very  violent  cafes  only. 

In 


v/hich  not  only  often  endangers  the  patient's  life,  but  alfo  in  the  moft  com- 
«non  cafes  of  intermitting  fevers,  by  its  continuance,  weakens  and  impairs 
his  whole  habit  of  body." 

find's  Advice  to  Europeans,  Appendix,  p.  31.3. 

*  Med,  Fafts,  p,  221. 

-f  During  the  cold  fit  of  an  ague,  the  heat  is  confiderably  increafed, 
Swenke  in  his  HaEmotologia,  fays,  "  That  the  heat  in  the  cold  fit  is  lefs 
than  the  natural  heat."  But  his  experiments,  perhaps,  were  made  at  the 
firft  approaches  of  the  cold  fit,  when  the  obftruftions  in  the  capillaries  arc 
fonfidenble,  and  the  increafe  of  circulation  inconfiderable. 

Ibid,  p.  227, 


138  CURE      OF      THE 

Jn  the  advanced  ftate  of  moft  fevers,  patients  are 
often  very  good  judges  of  their  own  heat,  and  will 
frequently  call  out  for  cold  air,  which  they  find 
very  refrefhing.  But  as  this  is  not  always  the  cafe 
at  the  very  beginning  of  a  fever,  they  ought  to  have 
fome  perfon  to  feel  their  bodies  many  times,  in  a 
day,  in  order  to  regulate  the  heat  of  the  room,  and 
the  quantity  of  clothes  they  are  to  hav7e  upon  them. 
During  thefe  fymptoms  the  patient  fhould  be  al- 
lowed no  fpiritous  liquors,  ale,  wine,  or  wine 
whey,  no  broths,  or  animal  food,  no  cordials, 
volatile  falts,  or  ftimulating  aromatic  fpices  ;  and 
indeed  the  lefs  food  fhe  takes  the  better,  either 
liquid  or  folid,  duritig  the  continuance  of  the  cold 
fit.  At  the  beginjfting  of  the  fit,  if  (he  be  really 
colder  than  in  -health,  warm  flannels,  bags  filled 
with  toafled  grains,  bottles  with  hot  water,  or  hot 
bricks,  may  be  applied  to  the  patient's  feet  ;  but 
what  is  of  more  confequence,  her  limbs  fliould  be 
gently  rubbed  with  a  warm  hand,  or  with  flannel, 
to  prevent  the  blood  from  ftagnatingin  the  capilla- 
ries, and  fome  additional  clothes  ihould  be  laid 
upon  the  bed,  particularly  upon  the  legs  and  feet. 
It  muft  however  be  remembered,  that  thefe  clothes 
Ihould  be  taken  away  as  foon  as  ever  the  hot  fit  comes 
on,  at  which  time  an  emolient  clyfter  ihould  be  in- 
je&ed,  and  great  care  taken  to  fupply  her  with  plen- 
ty of  fmall  liquors,  fuch  as'  teas  of  all  forts,  thin  wa- 
ter gruel, butter  milk,  tamarind,  verjuice,  or  twomilk 

whey. 


PUERPERAL    FEVER. 

whey,  barley  water,  or  decoft.  pe&oral  very  H 
warmed,  or  even  entirely  cold*.  The  room  fhould 
now  be  {applied  not  only  with  plenty  of  frefh,  but 
of  cold  air.  The  bed  curtains  fhould  be  undrawn, 
that  the  bed  as  well  as  the  room  may  be  frequent- 
ly ventilated.  To  afcertain  the  degree  of  cold  nee- 
effary  is  impoflible.  The  patient's  fituation,  the 
violence  of  the  fit,  and  the  mildnefs  or  feverity  of 
the  feafon  muft  determine  it.  It  will  however,  in 
general,  be  good  to  reduce  the  degree  of  the  pa- 
tient's heat  as  near  as  poffible  to  the  ftandard  of 
perfect  health.  The  fooner  this  is  done,  and  the 
nearer  her  heat  is  brought  to  this  ftandard,  the 
milder  will  the  fucceeding  fymptoms  be,  and  the 

fooner 

*  In  the  cafe  of  Georgias's  wife  in  Lariffa,  which  Hippocrates  has  given 
us,  who  had  a  fever  for  the  three  firft  days  of  her  lying  in,  attended  with 
great  thirft  and  lofs  of  appetite,  he  fays,  "  The  coldeft  water  was  of  fer- 
vice  to  her,  but  wine  by  no  means," 

On  Epidemics,  Book  5,  Cafe  it. 

Doftor  Kirkland  relates  the  cafe  of  a  women  in  the  feventh  month  of  her 
pregnancy,  who  was  feized  with  a  pleuro  peripneumony,  attended  with 
many  alarming  fymptoms,  when  bleeding,  bliftering,  and  other  proper 
remedies,  were  employed  to  advantage  ;  but  me  received  great  relief  from 
keeping  out  of  bed  feveral  hours  every  day,  in  a  large  room,  filled  with 
cold  air,  by  the  windows  and  doors  being  fet  open,  and  when  fhe  was  fup- 
ported  by  pillows  upon  the  bed,  for  fhe  could  not  lie  down,  (he  had  but 
little  more  than  a  fheet  to  cover  her.  At  firft  fhe  drank,  cold  water  with  a 
toaft,  in  moderate  quantities  ;  but  afterwards,  when  the  violent  heat  abated, 
and  fhe  began  to  expectorate,  the  liquids  fhe  drank  were  very  properly  or- 
flered  to  be  made  rather  warm. 

Reply  to  Maxwell,  p,  86, 


CURE    o*    THE 

fooner  will  the  fweating  fit*  come  on  ;  which  if 
it  be  fpontaneous,  and  not  forced  by  hot  air,  too 
many  clothes,  hot  liquors,  or  hot  medicines,  will 
in  all  probability  terminate  the  diforder,  but  though 
liquors  given  perfectly  cold  are  proper  during  the 

hot 

*  Mr.  Alexander,  of  Edinburgh,  in  his  Experimental  Eflays,  has  given 
us  feveral  experiments  on  fudorifics.  He  fays,  "  Thefe  experiments  feem 
clearly  to  prove,  that  there  is  a  certain  degree  of  heat,  which  may  be  called 
the  fweating  point,  always  abfolutely  neceffary  to  produce  that  evacuation, 
and  that  the  farther  the  heat  of  any  perfon  is  advanced  above,  or  reduced 
below,  this  ftandard,  the  farther  he  is  removed  from  any  poflibility  of 
fweating.  But,  although  there  is  a  flandard  degree  of  heat,  at  which,  and 
perhaps  at  no  other,  a  fweat  can  be  produced,  yet  we  may  reafonably  con- 
elude  that  this  degree  is  not  the  fame  in  all  perfons,  nor  in  the  fame  perfon 
at  all  times,  but  that  it  rather  differs,  according  to  the  difference  of  confti- 
tutioaal  heat,  and  other  circumflances," 

Experimental  Effays,  p.  166", 

"  That  profufe  fweating  is  more  deftruftive  to  the  natural  heat  and 
itrength,  than  even  pretty  large  blooding,  is  a  truth  which  feems  never  to 
have  been  fufficiently  attended  to  in  practice  ;  and  it  is  no  very  uncommon 
riling  to  fee  a  perfon  thrown  into  a  large  and  continued  fweat,  without  any 
apprebeniion  of  danger,  when  at  the  fame  time  were  he  to  lofe  a  fingle  ounce 
of  blood,  it  would  be  reckoned  highly  imprudent,  as  detracting  from  that 
flrength  which  ought  to  have  fupported  him  in  the  difeafe.  How  far  this  is 
reconcileable  to  common  obfervation,  and  the  feelings  of  every  one  who  has 
been  in  thefe  circumllances,  I  fhall  leave  to  the  judicious  to  determine. 

"  Dr.  Huxham,  that  careful  obferver  of  nature,  is  the  only  author  I  have 
met  with  who  feems  to  have  been  fully  aware  of  the  fatal  confequeaces  of 
large  fweating  in  low  putrid  diftempers,  and  accordingly  exclaims  againftit 
in  the  keeneft  ami  moft  nervous  manner,  as  havjng  a  very  direft  tendency 
toward  the  deftruftion  of  the  patient.  But  I  carry  the  matter  flill  farther, 
and  affirm ,  that  in  all  diftempers  whatever,  profufe  fweating  too  long  con- 
tinued, may  have  the  fame  effeft,  and  that  it  feldom  or  never  can  be  ufeful, 
as  all  the  puxpofes  of  it  may  be  fully  anfwered  by  a  gentle  mador  on  the 

fkin, 


PUERPERAL    FEVER. 

hot  burning  fit,  yet  they  muft  not  be  given  during 
the  fweating  fit.  The  heat  of  new  milk  will  be 
the  mod  proper  temperature.  If  nature  be  not  in- 
terrupted, fhe  ufually  difcharges  the  morbific  mat- 
ter 

&in,  which  may  be  much  longer  continued  with  lefs  hurt  to  the  ftrength  of 
the  patient." 

Experimental  Eflays,  p,  174,  175, 

"  And  we  fee  from  the  above  experiment,  that  toward  the  end  of  a  large 
and  long  continued  fweat,  a  quick,  weak,  tremulous  ptilfe  comes  on.  When- 
ever we  meet  with  one  of  this  kind,  we  ought  to  confider  it  as  a  ftrong  in- 
dication of  the  weaknefs  of  nature,  and  therefore,  in  my  opinion,  to  be 
nearly  as  cautious  of  fweating,  as  of  blooding." 

Ibid.  p.  177. 

'*  The  following  Corollaries,  drawn  from  experiments  and  obfervation, 
siay  perhaps  throw  fome  light  upon  this  fubjeft. 

Cc  Coroll.  i.  When  the  velocity  of  the  blood  i*  too  great,  and  its  mo- 
mentum too  little  in  proportion,  fweating  will  generally  increafe  the  veloci- 
*y,  and  dimini/h  the  momentum. 

"  Coroll.  2.  When  the  velocity  of  the  blood  is  too  little,  and  its  mo- 
mentum too  great  in  proportion,  fweating  will  generally  diminim  the  veloc- 
ity, and  increafe  the  momentum, 

*'  Coroll.  3.  When  the  velocity  and  momentum  of  the  blood  are  both 
too  great,  fweating  will  weaken  both  ;  but  if  it  is  continued  long  enough  to 
exhauft  the  natural  ftrength,  it  will  then  again  increafe  the  velocity,  but  not 
the  momentum* 

"  From  thefe  corollaries  we  may  form  a  fort  of  general  plan,  when  fweaN 
ing  is  ufeful,  and  when  not.  Laying  it  down  therefore  as  a  poftulatum  that 
the  ftrength  of  nature  depends  more  upon  the  momentum,  than  upon  the 
velocity  of  the  blood,  whenever  we  find  a  fweat  increafmg  the  velocity,  and 
diminifhing  its  momentum,  we  are  furethatitis  weakening  the  patient,  and 
therefore  muft  endeavour  t«  flop  it,  Agaia  when  we  find  a  fweat  increafiog 

the 


142  CURE      OF     THE 

ter  of  this  paroxifm  by  fweat  ;  and  this  fweating/ 
which  commonly  ends  in  a  few  hours,  may  in  foirie 
meafure  be  called  critical.  If  it  laft  longer,  it  < 
weakens  and  relaxes  the  patient,  quickens  the  pulfe, 
diminifhes  the  momentum  of  the  blood,  creates 
thirft  and  coftivenefs,  leflens  the  milk  and  lochia, 
occafions  their  abforption,  brings  on,  or  increafes 
putridity,  and  frequently  introduces  eruptions  of 
the  white  or  red  kind,  and  not  uncommonly  of  both. 

If  the  patient  be  troubled  with  pains  in  her  head, 
back,  or  loins,  attended  with  a  fwelling,  pain  and 
tenfenefs  in  the  lower  part  of  the  abdomen,  a  nau- 
fea,  vomiting,  diarrhea,  tenefmus,  frequent  mo- 
tions to  make  water,  a  quick  pulfe,  thrift,  and  a 
white  or  brown  tongue,  or  with  any  of  thefefymp- 
toms,  it  is  neceflary  to  give  her  a  gentle  emetic, 
confifling  either  of  ipecacuanha*  in  fubftance,  or 

of 

the  momentum,  and  diminifhing  the  velocity  of  the  blood,  we  may  be  Cure 
that  it  is  then  emptying  the  overloaded  veflfels,  or  opening  fome  obftru&ions, 
and  in  one  of  thefe  ways  adding  to  the  natural  ftrength.  Farther,  when  we 
find  a  fweat  diminishing  the  velocity  and  momentum  of  the  blood,  when 
they  are  both  top  great,  we  have  reafon  to  believe  it  is  then  carrying  off  fome 
morbific  matter,  whic4i  was  the  caufe  of  this  augmentation,  and  therefore 
may  go  on  with  the  fweat  almoft  as  long  as  we  find  the  momentum  and  ve- 
locity diminifh  in  an  equal  proportion  to  each  other  ;  for  we  may  be  affur- 
cd,  that  while  they  do  this,  nature  is  never  weak  ;  as  very  few,  if  any  in- 
ftances  ever  happen,  where  great  weaknefs  is  not  attended  with  a  very  quick 

pulfe." 

Alexander's  Experimental  Eflays,  p,  207,  8,  9. 

"  The  method   of  cure,  therefore,  eflablifhed  at  prefent   in   the  Hotel 
"  Dieu,  and  which  has  never  yet  failed  of  fuccefs  fmce  it  was  applied,  con* 

"  fills 


PUERPERAL  FEVER. 

of  fome  antimonial  preparation,  emetic  tartar  for 
inilance,  elfence  of  antimony,  antimonial  wine,  or 
James's  powder.  The  dofe  mould  be  repeated 
once  or  twice  a  day,  or  as  often  as  is  found  necef* 
fary  to  cleanfe  the  ftomach  of  phlegm,  bile,  gaftric, 
or  pancreatic  juice,  with  all  of  which  it  is  gener- 
ally overloaded  during  the  diforder.  Whichfo- 

ever 

**  fifts  in  taking  the  advantage  of  the  moment  of  attack,  and  giving,  with- 
*'  out  lofing  an  inftant  of  time,  fifteen  grains  of  ipecacuanha  in  two  dofes^ 
"  at  the  diftance  of  an  hour  and  a  half  from  each  other,  and  repeating  them 
c<  again  the  next  day  in  the  fame  manner,  whether  the  violence  of  the 
"  fymptoms  be  abated  or  not  :  And  if  the  difeafe  fhould  continue  much 
"  the  lame,  they  are  repeated  again  the  third,  and  even  the  fourth  day,  ac» 
"  cording  as  the  cafe  may  require.  In  the  intervals  between  the  dofes,  the 
"  effect  of  the  ipecacuanha  is  kept  up  by  a  portion,  compofcd  of  two 
"  ounces  of  oil  of  fweet  almonds,  one  ounce  of  fyrup  of  marfh  mallows, 
*'  and  two  grains  of  Kerme's  mineral.  The  common  drink  is  linfeed  tea, 
"  or  an  infufion  of  fcorzonera,*  edulcorated  with,  fyrup  of  althaea  ;  and  to- 
"  wards  the  feventh  or  eighth  day  of  the  difeafe,  the  patient  takes  a  milk 
"  purgative,  which  is  repeated  -three  or  four  times,  according  to  the  exi« 
"  gency  of  the  cafe* 

**  It  is  evident,  therefore,  that  the  efficacy  of  this  method  of  cure  confilb 
"  wholly  in  its  early  application,  namely,  in  the  very  moment  when  the 
"  difeafe  firft  commences  :  And  though  experience  has  fmce  taught  us  that 
t(  the  Ibfs  of  a  few  hours  is  not  always  irreparable,  yet  it  feldom  happens 
«'  that  ipecacuanha  has  the  fame  complete  fuccefs  when  the  firft  moment  of 
"  attack  is  loft." 

Vid.  Whitehead's  Tranf,  of  Doulcet's  Memoirs,  p.  10. 

The  invention  of  the  above  method  of  curing  this  diforder,  by  giving 
vomits  at  the  very  firft  at';ack  of  it,  and  frequently  repeating  them,  cannot 
be  afcribed  to  Mr.  Doulcet,  fmce  Dr.  Denman,  in  his  Eflay  on  the  puerpe- 
ral fever,  publifhed  in  1768,  advifed  the  ufe  of  them  with  this  difference 
only,  that  he  refcpmmended  tartar  emetic,  whereas  Mr.  Doulcet  gives  ipecac- 
uanha 

*  Scorzonera  latifolia,  Cafp,  Bauhin.  Angl.  Viper's  Grafs, 


CURE    OF    T  H  i 

ever  of  thefe  medicines  is  made  ufe  of,  it  mould  b6 
given  at  firft  in  a  fmall  quantity,  and  if  no  viable 
effeft  enfue,  if  it  neither  affed  the  patient  by 
flool  or  vomit,  the  fucceeding  dofes  mould  be  in* 
creafed,  till  their  quantities  are  fuch  as  will  anfwer 
their  intentions*  Frequent  vomits  are  very  ufeful 
In  all  putrid  fevers,  for  the  faliva*  which  is  f wal- 
lowed into  the  flomach,  and  the  other  juices  that 
are  found  there,  and  in  the  duodenum,  contain  very 
little  or  no  fixed  air,  and  therefore  of  courfe  ab- 
forb  the  putrid  miafmata,  which  cannot  too  often 
be  evacuated.  But  if  the  patient  have  very  vio- 
lent pains  in  the  abdomen,  purgatives  are  to  be  pre- 
ferred to  emetics,  as  the  a6lion  of  vomiting  might 

increafe  thofe  pains. 

If 

cuanha  the  preference.  But  in  this  Treatife  of  mine,  which  was  publilhed 
fn  1773,  *  recommended  ipecacuanha  in  fub fiance,  and  as  it  was  tranflated 
in^o  French,  and  publimed  at  Paris  in  1774,  it  is  moft  probable  Mr.  Doulcet 
muft  have  feen  it,  fmce  he  appears  by  his  memoir,  never  to  have  ufed  this 
mode  o£  treatment  till  that  time.  We  muft  however  allow  that  Mr.  Doul- 
cet has  very  properly  laid  particular  ftrefs  upon  the  ipecacuanha  being  given 
at  the  very  inftant  of  the  attack  ;  and  the  public  are  much  indebted  to  M. 
Viccj.  .D'Azyr,  and  the  gentlemen  of  the  Royal  Medical  Society  of  Paris, 
for  the  report  which  they  publimed. 

*  "  The  abforbent  quality  ofthcfaliva  moreover  fhews,  how  apt  it  muft 
be  to  lay  hold  of  infectious  miafmata  which  oftentimes  are  in  reality  putrid 
%'apours,  or  fixed  air,  detached  from  bodies  during  putrefaction  j  and  con- 
firms what  hath  been  frequently  recommended,  namely,  to  (hake  off  infec- 
tion, and  prevent  the  miafmata  from  getting  into  the  mafs  of  fluids  by  imme- 
diate vomiting  j  and  we  may  likewife  fee,  that  the  cautions  given  by  authors 
concern; ng  the  fwallowing  ottbcJaRva  while  in  the  places  abounding  with 
ic;eili(xis  vapours,  are  founded  in  reafon." 

Macbride's  Exper.  Efiays,  p.  268. 
By 


PUERPERAL  FEVER.          145 

If  the  patient  be  coflive,  or  have- a  tenefmm, 
emollient  clyfters,  which  hot  only  help  to  carry  off 
the  morbific  matter,  but  are  extremely  ufeful  as 
fomentations  to  the  whole  abdomen,  mould  be 
frequently  injected ;  but  efpecial  care  mould  be 
taken  that  they  are  not  adminiftered  too  warm  ; 
and  if  thefe  be  not  fufficient,  gentle  purgatives 
muft  be  adminiftered  in  fmall  dofes,  and  frequent- 
ly repeated,  as  cream  of  tartar,  Glauber's,  Ro- 
chelle,  or  Epfom  falts,  rhubarb  or  caftor  oil  ;  if 
thefe  mould  fail,  ftill  ftronger  muft  be  made  ufe  of. 

So  foon  as  the  ftomach  and  bowels  have  dif- 
charged  their  morbific  contents,  fpiritus  mindereri, 
or  the  fait  of  wormwood  neutralized  with  the  juice 
of  lemons  may  be  given  in  draughts.  This  laft 
medicine  mould  be  taken  during  the  aft  of  effer- 
vefcence  ;  or  it  may  be  more  agreeable  to  the  pa- 
tient if  the  fait  of  wormwood  be  adminiftered  in 
draughts  of  a  fcruple  each,  and  each  draught  wafh- 
ed  down  with  a  fpoonful  of  lemon  juice  ;  and 
probably  the  taking  it  in  this  manner  may  be  ful- 
ly as  effectual,  as  they  will  e'ffervefce  in  the  ftom- 
ach. Thefe  dofes  mould  be  repeated  every  two 

•_-•'-  j 

hours 

By  the  precautions  taken  by  Dr,  Lind,  and  by  immediate  vomitings,  on- 
ly  five  perfons  died  from  among  more  than  an  hundred,  who  were  feverally 
and  fome  of  them  conftantly  employed,  during  eighteen  months,  in  various 
Offices  about  the  fick  in  Haflar  hofpital,  -where  there  conftantly  was  a  great 
number  of  people  ill  of  fevers  that^were  highly  infectious. 

See  his  Difcourfe'  on  Fevers  and  Infcfliw,  paper  a,  p,  74,, 

K 


146  C  U  R  E      O  F      T  H  E 

hours  or  oftener  ;  they  will  corre&  and  fweeteri 
the  acrid  putrid  bile,  and  will  allay  the  feverifli 
fymptoms.  Doftor  Lind,  who  has  prefcribed  them 
frequently  upon  the  acceffion  of  cold  fits,  tells  us 
that  they  generally  Ihorten  the  fits,  and  occafion 
profufe  fw eatings.  It  may  be  neceffary  perhaps  to 
remind  the  reader,  that  though  fweatings  are  in 
general  very  pernicious  in  this  fever,  yet  they  are 
indifpenfably  neceffary  at  the  termination  of  a  rig- 
our, and  may  in  fome  meafure  be  faid  to  be  critical 
in  refpe6l  to  that  paroxifm,  though  there  be  not  a 
perfect  crifis :  that  the  beft  method  of  procuring 
thefe  fweats  is  to  moderate  and  fhorten  the  burn- 
ing fit,  for  Dr.  Alexander  has  proved  that  a  per- 
fon  may  be  too  hot  to  fweat,  and  that  there  is  a 
fweating  point,  in  any  degree  of  heat  above  or  be- 
low which  a  perfon  cannot  fweat.  Therefore  if  the 
patient  be  too  hot  to  fweat,  that  heat  muft  be  low- 
ered by  cold  air  and  cold  water.  By  thefe  means 
the  burning  ^fit  will  be  moderated  and  fhortened, 
and  fweats  will  natually  fucceed,  and  will  only 
continue  a  proper  time,  if  they  be  not  encouraged 
by  warm  liquors,  a  warm  room,  and  many  clothes ; 
hence  the  velocity  and  momentum  of  the  blood 
which  before  were  too  great,  will  now  be  leffened, 
whilfl  the  morbific  matter  is  carrying  ofF,  which 
was  the  caufe  of  the  augmentation. 

Riverius 


PUERPERAL    FEVER. 

Riverius*  gave  fait  of  wormwood  and  juice  of 
lemons  in  obftinate  vomitings  attendant  upon  pu- 
trid malignant  fevers.  Sydenham  adminiftered  a 
fcruple  of  fait  of  wormwood  in  a  fpoonful  of  lem- 
on juice,  during  the  illiac  paflion  which  fucceeded 
the  depuratory  fever,  ahd  in  an  intermittent  fever 
attended  with  almofl  continual  vomitings,  he  gave 
the  fame  quantity  fix  or  eight  times  in  the  fpace  of 
two  hours.  I  have  prefcribed  this  medicine  in  the 
aft  of  effervefcence  for  many  years  during  every 
ftage  of  the  putrid  malignant  fever,  both  in  preg- 
nant and  puerperal  women  with  every  apparent  ad- 
vantage; This  practice  has  been  recommended  by 
Whytt,  Barry,  both  the  Linds,  Pringle,  and  Mac- 
btide,  who  agree  that  the  virtues  of  this  medicine 
depend  upon  the  emiflion  of  the  fixed  air,  but  they 
differ  iri  regard  to  the  mode  of  its  action  ;  fome  are 
of  opinion  that  it  is  owing  to  itsbrifk  and  unufual 
Jlimulus^  on  the  very  fenfible  nerves  of  the  ftomach, 

others 

*  "  Salis  abfinthii  Bj.  curii  fucci  limonum  cochleari  mixtus,  remedium 
eft  praeftantiflimum,  praefertim  in  vomitu,  qui  febribus  malignis  folet  con- 
tingere." 

Lib.  9.  Cap.  7.  de  Naufea  &  Vomitu. 

f  «  The  draughts  of  fait  of  wormwood  and  juice  of  lemons  are  obferved 
"  in  a  great  meafure  to  lofe  their  power  of  flopping  a  vomiting  when  they  are 
<*  not  fwallo  wed  in  the  ac~l  of  efFervefcence  :  And,  ,1  Is  not  their  fuperior  an- 
tc  tiemetic  power  in  this  ftate  owing  to  their  making  a  much  ftronger  impref- 
««  fion  upon  the  nerves  of  the  ftomach,  while  they  continue  to  emit  this  fix- 
"  ed  air,  and  when  all  their  parts  are  in  violent  motion,  than  after  fa-turation, 
«  when  they  can  aft  only  by  their  faline  quality  ?  for  while  the  nerves  of 

"  the- 
K2 


14$  CURE    "OF     THE 

others  to  its  antifeptic  powers,  by  fweetening  and 
deftroying  the  putrefa&ive  acrimony.  But  which 
ever  of  thefe  is  the  cafe,  it  certainly  moderates  the 
cold,  the  hot,  and  the  fweating  fit  ;  it  allays  thirft. 
vomiting  and  the  febrile  heat  ;  it  keeps  the  intefti- 
nal  canal  open,  and  it  raifes  the  fpirits  without 
heating  the  patient.  I  have  never  known  the  leaffc 
bad  confequence  attend  the  taking  of  it,  except  that 
it  has  in  fonie  cafes  caufed  an  uneafinefs  at  the 
ftomachj  owing  to  its  fudden  diftenfion,  from  the 
quantity  of  fixed  air  fet  at  liberty.  This  effect  may- 
be moderated  by  fuffering'fo  much  of  the  effervef- 
cence  to  fubfide  before  taking  it,  as  may  be  judg- 
ed necelTary  ;  it  is  never  more  than  a  temporary 
inconvenience  ;  if  the  vapour  be  imbibed  into  the 
lungs  it  will  fweeten  the  breath,  which  in  its  pureft 
Hate  and  in  :health  is  feptic,  but  in  putrid  fevers 
moft  remarkably  fo. 

Notwithftanding  the  ingenious  Dr.  Macbride's 
experiment  with  the  fparrow,  and  the  general  opin- 
ion that  fixed  air  arifing  from  the  union  of  the 
mildeft  alkaline  falts,  and  even  the  pureft  vegeta- 

ble 

**  the  ftomach  are  affefled  with  this  briik  and  tmufuaI_/?z^M/ttJ,  that  difagreeable 
*f  fenfation  which  pro^nced  the  vomiting  muft  be  leffcned  or  deftro^'ed  : 
<f  And,  i  Is  not  theeffeft  which  thofe  draughts  fometimes  have  in  preventing 
*f  the  attack  of  intermittent  fevers  to  be  afcribed  folely  to  their  aftion  on  the 
*{  very  fenfible  nerves  of  the  ftomach,  and  not  to  any  fudden  change  which 
**  they  may  be  fuppofed  to  produce  in  the  nature  of  the  humours  contained 


Whytt's  Works,  410,  Edit,  p,  698, 


PUERPERAL    FEVER. 

ble  acids,  fiich  as  fait  of  wormwood  and  juice  of 
lemons,  cannot  without  immediate  danger  of  life 
be  admitted  into  the  lungs,  I  am  convinced  from  a 
number  of  trials  I  have  made  upon  living  human, 
fubje&s  of  all  ages,  that  it  may  be  admitted  into 
the  lungs  with  the  greatefl  fafety  not  only  when  they 
are  in  a  found  but  even  in  a  difeafed  ftate.  I  have 
likewife  ufed  in  the  fame  manner  chalk  as  well  as 
the  alkaline  falts  with  the  vitriolic  acid,  and  never 
found  any  inconvenience,  except  the  fixed  air  was 
thrown  into  the  lungs  in  too  large  quantities,  and 
then  only  a  temporary  giddinefs  ;  but  for  internal 
ufe,  vegetable  acids  feem  to  claim  the  preference*'. 

If,  notwithftanding  the  ufe  of  thefe  medicines, 
and  the  repetition  of  the  emetics,  the  naufea  and 
vomiting  continue,  fo  that  there  is  reafon  ftill  to 
fufpecl;  a  redundancy  of  vitiated  bile,  a  fcruple  or 
half  a  drachm  of  the  powder  of  columbo  root  or  its 
extract,  or  a  few  fpoonfuls  of  the  infufion  of  it, 
may  be  given  three  or  four  times  a  day.  If  the 
patient's  loofenefs  be  too  violent,  this  medicine 
will  agree  better  than  the  netitral  mixtures,  which 
generally  promote  that  difcharge,  but  if  the  intefti- 
nal  canal  be  not  fufficiently  open,  either  the  neu-^ 
tral  mixtures  mufl  be  continued,  or  fome  neutral 

falts, 

For  a  farther  account  of  the  medicinal  application  of  fixable  air  I  muft 
r  my  readers  to  fome  ufeful  Experiments  and  Observations  on  Mephitic  Airt 
published  by  my  ingenious  friend  Dr.  Fercival. 

PercivaPs  Effays,  Vol.  3; 


CURE      OF     THE 

falts,  fuch  as  vitriolated  tartar,  to  the  quantity  of 
half  a  drachm,  be  added  to  each  dofe  of  columbo* 
Small  dofes  of  rhubarb  may  be  adminiftered  at 
proper  intervals,  and  if  there  be  great  figns  of  ir- 
ritation, provided  there  be  no  delirium,  opiates, 
efpecially  if  a  grain  of  ipecacuanha  be  added  to 
each  dofe,  may  be  given  with  fafety  and  advan- 
tage. If  a  cough  and  difficulty  of  breathing  come 
on,  a  few  grains  of  ipecacuanha,  or  as  much  as  will 
occafion  a  gentle  puking,  will  fometimes  relieve 
the  patient.  If  pains  of  the  fide  or  any  part  of  the 
thorax  attack  her,  I  have  known  the  Senegal  rattle- 
fnake  root,  taken  to  the  quantity  of  half  a  drachm, 
three  or  four  times  a  day,  remove  them. 

If  the  diarrhea  be  immoderate  and'  fink  the  pa- 
tient, me  muft  be  properly  fupported  :  For  this 
purpofe,  (he  mould  have  falep  with  a  little  wine, 
or  brandy  in  it,  common  fago,  or  the  jelly  of  the 
North  American  fago  powder,  an  infufion  of  well 
toafled  bread,  ftrong  coffee,  boiled  milk  and  flour, 
a  ftrong  deco&ion  of  horfe  beans,  with  a  little 
fpiritous  cinnamon  water  ;  and  if  the  fever  be  a- 
bated  fhe  may  have  cordial  juleps  conlifling  of  co- 
lumbo,  ccnfe6L  cardiac,  confecl:.  democrat,  extract, 
lign.  camp.  gum.  rubr.  ailring.  draughts  compofed 
of  the  jelly  of  Englifh  ftarch  made  with  fimple 
cinnamon  water,  adding  to  each  draught  half  an 

ounce 


PUEfcPERALFEVER.        151 

ounce  of  tinft.  ftypt.  ;  and  ft  arch  clyfters  may  be 
injected,  to  which  may  be  added  opiates  if  neceffa- 
ry.  In  this  flate  of  the  difeafe  I  have  experienced 
the  good  effects  of  fmall  dofes  of  ipecacuanha  giv- 
en as  an  alterative. 

When  this  diforderis  in  its  decline,  the  bark,  and 
the  acid  elixir  of  vitriol  with  Pyrrnont  and  Seltzer 
water,  are  proper  to  brace  and  flrengthen  the  pa- 
tient, and  if  there  be  any  figns  of  the  fever  remain- 
ing, the  Seltzer  water,  as  it  is  lefs  heating,  is  to  be 
preferred  to  that  of  Pyrmont. 

Whatever  figns  of  inflammation  may  appear  at 
the  beginning  of  this  diforder,  it  is  agreed  by  all  au- 
thors that  they  do  not  continue  long.  The  difeafe 
generally  foon  puts  on  the  form  of  putridity. 
Foul  ftagnated  air*,  human  effluvia^  heat  moift- 
ure,  and  animal  food,  the  great  promoters  of  pu- 
trefa&ion,  mould  therefore  ftudioufly  be  avoided. 

Free 

*  *.'  Animals,  even  the  mod  tenacious  of  Kfe,  and  thofe  whofe  exiftence 
is  found  to  depend  the  leaft  on  air,  (boner  expire  in  air  made  foul  than  in 
vacuo. — Plants  fooner  fuffer,  and  droop  beneath  the  influence  of  noxious 
fleams,  than  in  a  want  of  this  all  vivifying  fluid." 

kind  on  the  Health  of  Seamen,  p.  8i» 

«'  More  danger  is,  doubtlefs,  to  be  apprehended  to  the  fick,  from  breath- 
ing in  air  polluted  with  their  own,  and  the  effluvia  of  others,  than  from  any 
degree  of  cold  which  can  well  be  admitted  by  frefh  air>" 

Ibid.  p.  85. 

K4 


C  U  R  E  OF  THE -- 

Free  and  even  cold  airf ,  an  upright  pofture,  clean- 
linefs,  fruifcj  frefti,  or  preferved,  a  vegetable  diet, 
and  the  ufe  of  cold  acidulated  liquors,  fhould  be 
ftri&ly  enjoined,  fuch  as  imperial,  orange,  or  lem- 
onade, Sec.  the  vegetable  acids  *  are  to  be  prefer- 
red 

-f  tl  When  the  hofpital  fever  in  the  late  war,  was  brought  from  England 
into  the  hofpital  at  Mahon,  the  houfe  being  found  inefficient  for  the  recep- 
tion of  fo  great  a  number  of  patients,  tents  were  reared  up  in  the  fields  for 
many  of  the  men.  Thefe  poor  fellows  were  thought  to  be  badly  accommo- 
dated, but  it  was  very  obfervable,  that  mofl  of  thofe  who  lay  in  the  cold  tents 
recovered  ;  when  the  mortality  in. the  houfe  was  fo  great,  that  in  fome  wards 

not  one  in  three  efcaped." 

Ibid.  p.  106. 

*  "  From  thefe  experiments  may  be  deduced  the  great  utility  of  acids  in 
all  difeafes  which  either  proceed  from,  or  are  accompanied  by,  a  redun- 
dance and  depravation  of  the  bile.  And  thisfeems  to  be  the  cafe  with  nioft 
autumnal  fevers,  and  in  general  with  the  epidemics  of  all  hot  countries, 
efpecially  where  heat  and  moifture  are  conjoined.  For  the  former  promotes 
the  generation,  and  the  latter  the  putrefaction  of  the  bile/' 

Percival's  Exp««meAt»  on  Aftringents,  p.  155. 

"  The  difference  between  the  acTion  of  mineral  and  vegetable  acids 
QH  putrid  gall,  as  evidenced  in  the  preceding  trials,  is  deferving  of  particu- 
lar notice.  From  the  ignorance  of  this  diftinftion,  or  want  of  attention  to 
it,  I  believe  the  elixir  of  vitriol  is  often  exhibited,  When  vinegar,  or  the 
four  juices  of  vegetables,  would  be  much  more  ferviceable.  For  though  it 
is  the  common  property  of  all  acids  to  correct  the  putrid  acrimony,  yet  the 
power  of  fwectening  it  feems  to  be  peculiar  to  thofe  of  'the  vegetable  clafs. 
And  as  they  are  mildly  aperient,  at  the  fame  time  they  will  not  only  neu- 
tralifethc  feptic  comivies,  which  in  lome  difeafes  lodges  in  the  ftomach  and 
flexure  of  the  duodenum,  but  will  alfo  tend  to  evacuate  it  :  An  advantage  not 

?o  be  expefted  from  the  mineral  acids." 

Ibid.  p.  158. 

- 

*c.  Acids  correft  the  bitternefs  and  acrimony  of  the  bile  ;  and  volatile 
bitters  correft  the  acidity  and  tenacity  pf.  the  phlegm.    If  vin« 

egar 


PUERPERAL    FEVER.       153 

red  to  the  mineral,  they  not  only  correct,  but 
fweeten,  the  putrid  bile,  and  are  mildly  aperient, 
and  above  all,  we  muft  remember  to  keep  the  al- 
vine  tube  open. 

Every  method  recommended  in  the  preceding 
chapter  as  preventive  of  this  diforder,  mould  now 
be  enforced  in  a  higher  degree,  in  order  to  its  cure  ; 
particularly  the  patient  mould  have  clean  linen 
every  day,  and  her  hands,  face,  and  teeth  mould  be 
daily  warned  in  cold  water*,  except  (he  be  in  a 
fweat ;  me  mould  alfo  fit  up  in  bed  as  often  as  fhe 
can  bear  it,  and  be  got  out  of  bed  every  day. 

If 

cgar  be  mixed  with  ftrong  decoftions  in  water,  of  wormwood,  gentian 
root,  camomile  flowers,  centaury  tops,  and  buckbean,  the  mixtures  will  have 
neither  bitternefs  nor  acidity,  if  they  be  mixed  in  juft  proportions.    Hence 
acids  and  bitters  correft  each  other,  when  either  happens  to  abound  too  much 
in  the  body.     If  bile  abounds,  as  it  commonly  does  in  fummer  and  hot 
countries,  acids  and  cooling  acidulated  liquors  will  be  proper  to  correct  it ; 
and  if  phlegm  abounds,  as  it  does  in  winter  and  cold  countries,  volatile  al- 
kalious  fpirits  and  warming  fermented  liquors  will  be  proper  corre&ors." 
Robinfon  on  the  Virtues  and  Operations  of 
Medicines,  p.  168. 

"  Ex  aceti  partibus  quatuor,  &  bilis  recentis  part^bus  quinquc,  miftura 
fa£ta,  neutrius  faporem  prdebebat,  fed  medium  quendam,  mamfeftedulcem." 
Robertus  Ramfay  Differt.  Med.  Inaug.  de  Bile, 
exper.  xvii. 

**  Miftura  aceti  &  bilis,  ut  in  exp.  xvii.  fa&a,  lacli  reccnti  affufa,  coagulum 
hujus  non  induxit,  etfi  eadem  aceti  copia,  per  fe  affufa  plus  quam   fufficiens 

ad  coagulum  inducendum  fuiffet." 

Ibid,  exper,  xix. 

*   "  Frigus,  quatenus  corporis  calorem  &  cerebri  vel  nervorum  energismt 
minuit,  fedans  eft,    Si  calor  nimius  fit,  frigus  ad  eundem  compefcendum 

utile 


154  CURE    o  F    T  H  E 

If  thefe  dire&ions  be  timely  made  ufe  of,  before 
any  confiderable  abforption  has  taken  place,  or  any 
matter  depofited  in  the  cavity  of  the  abdomen,  I 
have  no  doubt  but  they  will  generally  prove  fuc- 
cefsful.  I  have  always  found  them  fo,  except  in 
cafes  wherein  the  womb  has  fuffered  damage  at 
the  time  of  parturition  ;  but  I  mult  inform  the 
reader  that  I  never  attended  a  woman  in  a  lying 
in  hofpital.  A  diaphorefis  or  gentle  fweat,  is  rec- 
ommended by  many  authors,  who  yet  allow  that  a 
diarrhea  is  critical,  that  it  is  the  way  which  nature 
takes  to  difburden  herfelf  of  the  morbific  matter, 
and  that  it  ought  by  no  means  to  be  checked.  It 
is  an  axiom  in  phyfic,  that  the  increafe  of  one 
evacuation  leffens  all  the  reft  ;  ^  Why  then  fhould 
an  evacuation  be  encouraged  which  relaxes  and 
weakens  the  patient,  increafes  the  velocity,  and  de- 
creafes  the  momentum  of  the  blood,  creates  third, 
leffens  the  milk  and  lochia,  promotes  putrefaftion 

and 

^>  *  ~i 

mile  eft.  In  plerifque  morbis  febrilibus,  caloris  ftimulus  movbum  exacer- 
bat,'  adeoque  frigus  ad  gratam  fenfationem  fere  femper  neceffarium  eft.  Si 
aec  inflammationis  topicae,  nee  diathefis  phiogifticz  periculum  fit,  aer  &  po- 
tus  frigidi/lib'ere  concefli,  multum  juvant.  In  ephemera  puerperarum  aqua: 
frigidze  hauftum  vel  manus  immerfionem  ut  remedium  eximium  laudat  Pro- 
feffor  nofter  Young,  et,  faepe  omnibus  aliis  anteponendum,  cenfet." 

Differt.  Med.  Inaug.  T.  Tucker,  p.  45. 

For  a  more  particular  account  of  the  great  advantages,  and  even  neceffity, 
of  cold  air,  in  fupprefiing  and  extinguishing  fevers,  I  muft  beg  leave  to  re- 
fer  the  reader  to  two  very  fenfible  pamphlets  publifhed  by  Doaor  Ki.kland, 
the  one  entitled,  An  E/ay  on  the  Cure  o/Difeafes  casing  fcccrs,  the  other,  A  Rt- 
p  )  to  Maxwell. 


PUERPERAL,  FEVER. 

and  abforption,  and  checks  that  loofenefs  which 
certainly  ihould  not  be  removed,  except  by  taking 
away  its  caufe  ;  I  mean  by  the  admiflion  of  free 
air  inftead  of  foul,  by  the  prevention  of  heat  and 
moiflure,  by  abflaining  from  fuch  foods  as  have  a 
putrefcent  tendency,  by  frequently  clean  (ing  the 
ftomach  and  bowels  of  the  corrupted  colluvies, 
by  correcting  and  fweetening  its  putrefcent  acri- 
mony, and  by  an  upright  pofition  preventing  a 
lodgement  of  any  kind  of  offending  matter,  either 
;n  the  uterus,  vagina,  inteftines,  or  bladder  ? 

I  do  not  deny  that  many  perfons  have  recovered 
who  have  been  kept  in  gentle  fweats ;  but  inflances 
of  the  recovery  of  patients  may  be  adduced,  un- 
der alrrioft  every  kind  of  erroneous  practice.  That 
many  have  recovered  without  fweating.  or  where 
the  fweat  has  only  come  on  at  the  termination  of 
the  paroxifmof  a  rigour,!  myfelfcan  teftify.  Ex* 
cepting  at  this  period,  I  am  equally  confident  that 
the  patient's  recovery,  without  fweating  in  the 
fmalleft  degree,  is  not  only  more  expeditious,  but  at- 
tended with  greater  certainty,  and  though  we  often 
fee  a  gentle  diaphorefis  upon  the  ikin  when  the 
fever  goes  off,  yet  we  ought  not  to  confider  it  as 
the  caufe,  but  the  confequence of  the  amendment; 
and  I  believe  I  may  venture  to  fay,  that  in  thofe 
few  cafes  where  fweating  has  proved  ferviceable, 

the 


156  CURE    or    THS 

the  fweats  have  come  on  fpontaneoufly,  and  were 
not  the  effe&  of  art. 

Nitre*  is  a  very  improper  medicine  in  this  fever, 
and  in  all  difeafes  where  putrid  bile  abounds. 

In  regard  to  phlebotomy,  efpecially  at  the  be- 
ginning of  this  diforder,  authors  are  much  divid- 
ed ;  fome  of  them  obftinately  infilling  upon  its 
efficacy,  and  others  as  warmly  rejecting  it.t 

That  fome  women  may  be  fubjeft  to  fuch  in- 
flammatory diforders  during  their  lyings  in  as  may 
require  bleeding,  cannot  be  denied  ;  but  cafes  of 
this  kind  are  not  very  common  in  the  prefent  age, 
efpecially  amongft  thofe  who  inhabit  large  towns. 
In  the  puerperal  fever,  however,  which  generally, 
fooner  or  later,  affords  linking  fymptoms  of  pu- 

trefcency,  we  fhould  be  extremely  cautious  how 

\ 

*_^  ,  >t  4  we 

*  Sir  John  Prihgle,  in  making  fome  experiments  upon  gall  to  preferve  it 
from  putrefaftion,  fays,  "  Only  nitre  failed,  -which  though  four  times 
"  ftronger  than  fea  fait  in  preferving  flefh,  is  inferior  to  it  in  preferving 
«'  gall,  and  much  weaker  than  fal  ammoniacus  ;  which,  again,  is  forhewhat 
"  lefs  powerful  than  nitre  in  keeping  flefh  fweet.  The  nitre  was  faon 
tC  opened  by  the  gall,  and  emitted  much  air,  which  arofe  as  from  a  fer- 
'*  menting  liquor,  and  when  this  happened  the  gall  began  to  putrefy.  But 
"  the  falinc  mixture  generated  no  air,  and  oppofed  the  putrefaction  of  the 
**  gall  more  than  it  did  that  of  the  flefh.  Perhaps  this  may  be  the  reafon 
"  why,  as  far  as  I  have  obferved,  nitre  difagrees  with  .the  ftomachin,  putrid 

*'  bilious  cafes." 

Append,  to  Difeafes  of  the  Army,  p.  27, 

i  Leveret  fays  he  had  never  feen  one  woman  efcape  after 
Aphorifm  995, 


PUERPERAL  FEVER. 

we  do  any  thing  to  debilitate  the  vis  vitas ,  to  weak- 
en the  circulating  powers  by  unneceffary  evacua- 
tions, or  wafte  the  ftrength  which  may  be  wanted 
to  fupport  the  patient  under  loofenefs  and  vomit-- 
ings. It  has  been  lately  obferved  by  DoQor  Den- 
man,  "  that  thofe  who  have  recovered  have  feem- 
"  ed  generally  to  owe  their  fafety  to  a  happy 
"  flrength  of  conftitution,  able  to  withftand  the 
"  continuance  of  a  long  loofenefs,  by  which  the 
"  difeafe  appeared  to  be  gradually  wore  off,  or  to 
<f  a  fpontaneous  vomiting/'* 

Such  is  the  rapid  progrefs  of  this  acute  diforder, 
that  if  the  patient  have  fuffered  any  unneceffary 
evacuations  in  the  firft  period  of  it,  by  bleeding 
or  fweating,  there  is  feldom  fufficient  time  to  re- 
cruit her  ftrength,  and  a  trifling  error  may  be  pro- 
ductive of  the  moft  fatal  confecjuences. 

Cafes  have  certainly  happened  wherein  women 
have  been  relieved  from  feverifli  indifpolitions  by 
fmall,  but  repeated  critical  difcharges  of  blood 
from  the  uterus  ;  but  it  does  not  from  hence  fol- 
low, that  the  lofs  of  blood  from  other  parts,  and 
that  too  procured  by  art,  will  have  the  fame  effefls. 

It  is  allowed  that  thefe  fevers  fometimes  arife 
even  after  large  uterine  effufions  ;  j  Ought  we 
then  to  expeci  to  cure  a  diforder  by  bleeding, 

which 

*  May  on  the  Puerperal  Fever,  p.  13. 


CURE    OF    THE 

which  bleeding  would  not  prevent  ?  It  is  a  maxini 
in  phyfic,   that  whatever  remedy  will  cure,  will 
prevent  a  diforder.     The  return  of  the  lochia  is 
fornetimes  one  of  the  firft  fymptoms  of  the  recove- 
ry, but  this  return  mud  be  underflood  rather  as 
the  effect  than  the  caufe.     This  matter  has  been  fet 
in  a  very  clear  light  by  Doctors  D^nman,  Johnfon, 
Millar,  and  Manning,  and  I  fhall  only  add,  that  I 
never  found  bleeding  neceffary,   except  when  in- 
flammations of  the  womb  have  been  brought  on  by 
violence  ufed  in  the  extraction  of  the  child  or  of 
the  fecundines.     In  cafes  of  this  kind  it  fhouldbe 
ufed  very  early,  as  foon  as  there  is  any  (ign  of  in- 
flammation, and  (as  puerperal   women  are  in  a 
date  much  inclined  to  putrefcence)  fhould  not  be 
repeated   without   the  greatefl  circumfpe&ion. — 
Fomentations,    and  common    warm    and   vapour 

baths  are  very  improper,  as  they  heat,  moiften,  and 

relax,  and  are  therefore  great  encouragers  of  putre- 
faction and  abforpfcion. 

!'>*.•-' 

Blifters*  are  generally  difapproved  by  all  writ- 
ers upon  thisfubject.  The  flimulus  they  occalion 

in 

*  "  Si  qui  puerperio  morbi  fupervenerint,  in  his  omnibus  adhibita  veficato- 
ria  inter  trcs  primos  dies  periculum  Temper,  faepe  mortem  afferunt." 

Manningham  Aph.  Med.  p.  153. 

Baglivy  relates  the  hiftory  of  a  puerperal  fever  unfuccefsfully  treated,  where 
blifters  were  attended  with  a  manifeft  difadvantage  to  the  patient.  "  Mulier 
ofto  menfmra  gravida,  juvenis,  &.  gracilis,  integro  oftiduo  doloribus  vcntris 

mokflata, 


PUERPERAL    FEVER. 

in  the  bladder  and  uterus,  and  the  bad  effeft  they 
fometimes  have  in  putrid  and  bilious  fevers,  when 
applied  too  early,  are  fufficient  reafons  to  condemn 
their  application  in  the  beginning  of  this  fever,  ef- 
pecially  if  foon  after  delivery. 

The 

moleftata,  demum  infantem  peperit.  Poft  partum  adhuc  continuabant 
dolores,  cum  infigni  ventris  tenfione.  Quoniam  vero  omne  genus  remedio* 
rum  fpreverat,  vel  potius  neglexerat,  demum  a  quodam  medico  quatuor  vefi. 
cantia  fibi  apponi  permifit.  Lochia  quz  primum  fluebant  exinde  fupprefla 
funt.  Faucis  poft  diebus  denuo  apparentibus  lochiis,  abdomen  graviter  con* 
velli  csepit  cum  infigni  dolore,  adeo  ut  ne  digito  quidem  premi  poffet ;  ex- 
inde fudores  frigidi,  cum  refrigeratione  extremorum  apparuerunt ;  pulfus  & 
refpiratio  erant  diminuta,  &  fere  ad  extremum  vitas  redafta  fuit  patiens. 
Elapfis  paucis  diebus  in  melius  aliquant ulum  procedebat  ;  derepente  tamen 
fupervenientibus  graviffima  fpirandi  difEcultate  ex  genere  convulfivarum,  & 
interdum  in  delirium  fe  commutante,  nee  non  alvi  fluxu  flavo,  &  fcetido, 
qui  per  ofto  dies  continuavit,  demum  decima  feptima  die  morbi,  obiit  pa- 
liens,"  &c.  Baglivi  oper.  p.  599. 

Etherington,  fpeaking  of  the  low,  nervous,  and  hyfteric  fever,  fays,  "  For 
although  bliflers  in  general  are  very  ferviceable  where  this  diforder  happens, 
yet,  to  lying  in  women,  they  prove  of  the  worft  confequence,  by  inflaming 
the  womb,  and  fometimes  bringing  on  mortifications  and  death.  For  which 
reafon  we  cannot  too  earneftly  forbid  the  ufe  of  blifters  in  all  diforders  of 
puerperal  women,  in  the  early  days  of  their  lying  in,  while  the  veffels  are  fo 
full,  and  the  parts  from  whence  the  placenta  was  feparated  fo  very  tender, 
and  liable  to  be  injured  by  the  cauftic  falls  of  the  cantharides.  Many  fatal 
inflances  attending  the  application  of  blifters  at  this  time  have  been  obferv- 
ed."  General  Cautions  in  the  Cure  of  Fevers,  p.  41 . 

"  1  do  not  know  any  worfe  practice  than  bliftering  in  the  beginning  of  fe- 
vers, particularly  the  putrid  and  bilious  ;  blifters  increafe  the  inflammation, 
and  greatly  exafperate  the  acrimony  of  the  morbid  matter  :  in  th6  early  part 
of  the  bilious  conftitution,  they  promote  the  propenfity  to  fymptoniatic  fweats, 

and  hinder  the  excretion  by  the  bowels." 

Grant  on  Fevers,  p.  344. 

"  Neither  do  blifters  feem  to  be  always  of  fervice  in  fevers  ;  for  fome  of 
the  putrid  kincj  djjjjplve  the  Wood,  and  turn  iato  a  dark  corrupted  fanies." 

Glafs'iCom.  275. 


*6o  CURE   OF,    &c. 

The  whole  clafs  of  ftimulating  medicines,  callect 
enimenagogues,  which  are  faid  to  promote  a  dif- 
charge  of  the  lochia,  are  equally  to  be  avoided. 
They  irritate  the  womb,  increafe  the  fever,  and  do 
not  anfwer  the  end  for  which  they  are  adminiftered. 

In  the  laft  flage  of  this  diforder,  when  the  pa- 
tient Teems  to  fink  under  it,  wemuft  endeavour  to 
fupport  her  by  ftrong  infufions  and  tin&ures  of 
the  Peruvian  bark,  by  wine  and  other  cordials,  and 
to  ftimul.ate  and  roufe  her  by  volatile  falts  and  blif- 
ters;  and  in  this  (late  of  the  difeafe  they  may  even 
be  applied  to  the  abdomen. 

I  mufl  not  omit  to  mention,  in  this  place,  the 
good  effe&s  I  have  experienced  from  emollient  or 
antifeptic  injections  into  the  uterus,  by  means  of  a 

large  ivory  fyringe,  or  an    claftic  vegetable  bottle. 

In  thofe  cafes  where  the  lochia  have  become  acrid 
or  putrid,  and  by  being  abforbed  into  the  circula- 
tion, havefefved  as  a  conftant  fomes  to  the  difeafe, 
I  have  by  this  means  known  the  fever  much  affuag- 
ed,  and  in  many  cafes  wholly  extinguimed ;  for 
though,  as  I  have  before  obferved,  the  quantity  of 
the  lochia  is  not  to  be  much  regarded,  the  quality 
of  this  difcharge  is  a  matter  of  infinite  importance* 


CHAP, 


CHAP.        VIII. 


OF  THE  CURE  OF  THE  MILIARY  FEVER. 


N  the  fixth  chapter  I  have  laid 
down  the  prophyla&ic  treatment 
of  this  diforder.  If  I  can  pro- 
nounce with  certainty  of  any 
medical  facl;,  it  is,  that  the  milia- 
ry  fevers  of  puerperal  women  may 
be  prevented  ;  and  I  am  equally  confident  that 
they  may,  in  their  firft  ftages,  be  totally  extinguifh- 
ed,  without  any  of  thofe  bad  confequences  which 
too  frequently  attend  them  when  they  are  fuffered 
to  take  their  ufual  courfe. 

As  foon  as  any  fymptoms  of  the  diforder  appear, 
whether  they  come  on  with  or  without  a  rigour,  a 
gentle  emetic  will  be  neceflary.  This  remedy  may 
be  adminiflered  at  any  time,  except  during  the  par- 
oxifm.  If  there  be  a  cold  fhivering  fit,  fucceeded  by 
L  burning  " 


life  CURE     OF    THE 

burning  and  fweating,  thefe  fymptoms  are  to  be 
treated  in  the  mariner  explained  in  the  laft  chap- 
ter. A  quarter  or  half  a  grain,  or  where  the  con- 
ftitution  is  remarkably  ftrong,  a  grain  of  emetic 
tartar  may  be  given  twice  a  day  or  oftener,  in 
draughts  ;  but  if  it  be  intended  to  aft  as  an  emetic, 

neither  cream  of  tartar  nor  any  other  acids  mould 

J 

be  given  along  with  it*.  If  thefe  dofes  do  not  oc- 
cafion  gentle  vomitings,  as  the  flomach  in  this  dif- 
order  is  generally  relaxed,  and  abounds  with  heavy 
phlegm  and  mucus,  'a  few  grains  of  ipecacuanha 
mould  be  adminiftered  every,  or  every  other  day, 
and  neutral  draughts  in  the  aft  of  effervefcence 
mould  be  given  every  other  hour. 

If  the  patient  be  coftive.  emollient  clyfters  Ihould 
Jbe  every  day  injefted.  They  allay  the  febrile  heat 
.and  prevent  loofenefs,  which  is  often  occaftoned 
by  the  feces  lodging  and  thereby  growing  putrid 
and  acrimonious  in  the  interlines.  An  upright 
pofture,  with  cold  liquors  and  free,  pure,  and  even 
cold  air,  accompanied  with  the  greateft  cleanlinefs, 
are  abfolutely  neceflary.  If  thefe  and  the  direc- 
tions given  in  the  preceding  chapter  be  properly 
purfued,  I  have  no  doubt  but  they  will  prove  ef-  \ 
feftual  in  totally  extinguifhing  the  fever.  Bleed- 


ing 


*  u  Cream  of  tartar  and  acids  check  the  operation  01  vomits,  but  more 
'efpeciajly  ojf  antimonial  vomits." 

Robinfon  on  the  Operation  of  Medicines,  p.  169, 


MILIARY   FEVER. 

ing  and  other  evacuations,  except  gentle  emetics 
and  emollient  clyfters,  will  be  unneceffary.  There 
can  be  indeed  no  objeftion  made  to  a  mild  purga- 
tive at  the  beginning  of  the  diforder,  provided  it 
be  not"  given  immediately  after  delivery.  Great 
care  and  circumfpe&ion  is  required  in  conducing 
the  patient  through  the  fecond  ftage  of  this  difor-» 
der,  when  there  is  a  large  crop  of  miliary  puftulee, 
efpecially  if  they  be  of  the  white  kind,  attend- 
ed with  a  quick  uneven  pulfe,  a  dry  tongue,  and  a 
continual  fweat. 

Though  it  be  in  this  cafe  abfolutely  neceffary  that 
the  patient's  linen  mould  be  frequently  changed, 
that  the  bed  curtains  mould  be  undrawn,  and  the 
room  ventilated,  and  though  it  may  fometimes  be 
expedient  that  a  current  of  frefh  air  mould  pafs 
over  the  patient,  yet  thefe  things  ought  not  to  be 
done  fuddenly  or  raihly ;  cautioufly,  and  by  de- 
grees they  may  be  performed  with  fafety.  The  de- 
gree of  cold  admitted  mould  be  fuch  as  will  reduce 
the  heat  of  the  body  as  near  as  poflible  to  the  ftand- 
ard  of  health,  fuch  as  will  prevent  the  patient's 
burning  or  fweating.  Intenfe  cold  is  feldom  nec- 
effary ;  but  where  it  is,  by  proceeding  with  proper 
care,  it  may  be  admitted  not  only  without  hazard, 
but  with  the  greateft  benefit. 

Evacuations  are  in  general  followed  with  the 
word  of  confequences.  A  few  loofe  ftools  (in  fome 
L  2  cafe 


CURE      OF     THE 

cafes  fpontaneous,  in  others  produced  by  art)  have 
funk  patients  beyond  recovery,  and  bleeding  has 
been  attended  with  as  bad  fuccefs. 

. 

I  remember,  not  without  great  concern,  that  in 
the  earlier  part  of  my  practice,  when  my  ideas  of 
phlebotomy  in  puerperal  cafes  were  very  differ- 
ent from  what  they  are  at  prefent,  I  was  called  to 
a  puerperal  woman  in  this  flage  of  the  miliary  fe- 
ver. She  had  a  plentiful  eruption  of  the  white 
kind,  was  in  a  fweat,  and  her  pulfe  was  fo  quick,  fo 
full  and  flrong,  that  I  was  prompted  to  believe  this 
evacuation  neceffary.  She  did  not  feem  to  be  in 
immediate  danger,  I  took  eight  or  ten  ounces  of 
blood  from  her  arm,  but  was  inftantly  convinced 
of  my  error.  Before  I  flopped  the  blood  me  began 
to  droop,  and  in  lefs  than  half  an  hour  expired. 

The  making  a  large  quantity  of  pale  thin  urine, 
a  common  fymptom  in  this  diforder,  always  weak- 
ens the  patient  to  a  great  degree.  All  diuretics 
muft  therefore  be  pernicious. 

I  have  known  the  hot  fweating  mode  of  practice 
carried  on  to  that  extreme,  that  the  feather  bed  has 
rotted  beneath  the  patient ;  by  this  method  me  has 
been  fo  much  exhaufted,  that  the  higheft  cordials 
have  been  neceffary  to  fupport  her,  nay  I  have  been 
credibly  informed  that  under  thefe  circumftances 
a  patient  has  fometim-es  drank  a  gallon  of  zuine,  in 


MILIARY   FEVER. 

a  fingle  day,  exclujlve  of  brandy,  and  of  the  cordials 
from  the  Apothecary  sjhop,  and  all  this  too  without 
intoxication.  Many  have  fallen  viclims  to  this 
practice,  and  thofe  who  have  recovered  under  it, 
have  in  general  been  fo  much  enfeebled,  and  have 
had  their  conftitutions  fo  far  broken,  that  during 
the  remainder  of  their  lives  they  have  been  liable 
to  frequent  returns  of  the  diforder  *. 

When  the  patient  has  been  kept  fweating  in  bed 
for  many  days  in  a  fupine  pofture,  her  fuddenly 

getting 

*  Etherington  fpeaking  of  the  miliary  fever  fays,  c<  The  ufe  of  fudorifics 
has  been  found  to  be  fuccefsful  neither  in  the  beginning,  middle,  nor  end  of 
this  fever  ;  although  the  foftnefs  of  the  pulfe  at  the  beginning  might  feem  to 
demand  the  warmeft  cordials  ;  or  its  weaknefs  during  the  eruption  to  make 
ftimulants  necefiary.  Neither  is  promoting  at  lafl  the  natural  fweat,  which 
appears  to  be  a  crifis,  beneficial. 

"  The  forcing  out  and  keeping  up  fweats,  upon  every  fufpicion  of  cold  or 
eruption,  I  know  is  warranted  by  vulgar  practice.  But  I  am  convinced  from 
repeated  examples,  that  fweating  in  all  eruptive  difcafes  is  attended  with  bad 
confequences.  Probably  from  carrying  off  the  thinner  fluids,  which  mould 
fupportand  keep  up  the  eruption." 

General  Cautions  in  the  Cure  of  Fevers,  p.  52. 

(t  I  have  more  than  once  known  patients  fink  under  this  fever,  after  hav- 
ing been  kept  in  a  fweating  method  for  five  or  fix  weeks  together,  and  after 
.    .     having  gone  through  three  or  four  fucceflive  crops  of  miliary  eruptions,  as 
they  are  called,  they  all  the  while  melting  away,  and  weltering  in  their  own 

fweat,  and  the  bed  rotting  under  them." 

Huxham  on  Fevers,  p.  87. 

«e  How  exceedingly  pernicious  hot  alexipharmic  medicines  are  in  the  mil- 
iary fever,  experience  hath  too  frequently  taught  us ;  by  which  it  appear* 

that 

O  ' 


i66  C  U  R  E     o  P    T  it  £ 

getting  out  of  it  has  fometimes  been  attended  with 
difagreeable  confequences.  Thefe  have  not  been 
owing  to  the  cold,  but  have  arifen  from  her  change 
of  poflure,  and  from  the  feeblenefs  of  the  mufcular 
fibres  of  the  heart,  which  profufe  fweats  had  great- 
ly debilitated.  I  have  known  feveral  perfons  who, 
under  thefe  circumftances,  notwithftanding  the 
greateft  care  to  prevent  the  effe&s  of  cold,  could  not 
bear  this  fudden  alteration  of  pofture.  All  evacu- 
ations, and  whatever  tends  to  weaken  the  tone  of 
the  veffels,  has  the  effect  of  fweating.  Sir  John 
Pringle  has  remarked,  "  That  nothing  can  be  low- 
((  er  than  the  fick  are  in  the  advanced  ftate  of  the 
"  jail  or  hofpital  fever,  and  that  therefore  Hoff- 
"  man  rightly  advifes  in  all  fuch  cafes  that  thepa- 
"  tient  may  be  kept  conftantly  in  bed,  and  not  be 
"  permitted  even  to  fit  up  in  it.  In  the  lafl  ftage 
"  of  this  difeafe,  as  well  as  in  that  of  the  fea  fcur- 
*(  vy,  it  fhould  feem  that  the  force  of  the  heart  is 
"  too  frnall  to  convey  the  blood  to  the  brain,  ex- 
"  cept  when  thfe  body  is  in  an  horizontal  pofture  *." 
But  as  an  horizontal  pofition  is  very  bad  in  all  fe- 
vers to  which  puerperal  women  are  fubjecl;,  I  al- 

ways 

that  by  means  of  fuch  medicines,  and  keeping  the  patient  too  warm,  almoil 
all  died  when  the  difeafe  made  its  firft  appearance  ;  whereas  at  prefent,  num- 
bers under  a  temperate  regimen  efcape.  In  a  neighbouring  town  this  year, 
a  great  many  in  the  petechial  fever  were  treated  with  hot  alexipharmics,'>and 
Kept  in  a  continual  fweat,  of  which  fcarce  a  third  part  recovered." 

Glafs's  Comment,  on  Fevers,  Eng.  edit.  p.  235. 


p.  3*4»  ito' 


MILJARY     FEVER. 


ways  advife  the  patient,  if  %e  .c^nn^t  fit  up  in  bed, 
to  have  feveral  pillows,  or  bolfters  fo  applied  to 
her  head  and  moulders,  as  to  raife  them  as  high  as 
ihe  can  bear  without  inconvenience. 

Bliftering  is  fo  far  from  doing  good  in  the  firft 
or  fecond  flages  of  the  miliary  fever  of  childbed 
women,  that  it  is  often  productive  of  much  mif- 
chief.  It  increafes  both  the  fever  and  the  number 
of  the  pu  Mules,  attenuates  the  blood,  increafes  the 
urine,  promotes  putrefaction,  caufes  thirft,  drynefs 
of  the  tongue,  watchings,  deliriums,  tenefmus,  fub~ 
fultus  tendinum,  hiccoughs,  arid  convulfions.  Nitre, 
efpecially  if  given  alone,  though  an  antifeptic,  hath 
no  place  in  this  diforder.  In  weak  and  delicate 
ftornachs  k  caufes  too  great,  a  chillnefs,  it  aug- 
ments the  patient's  anxiety,  adds  to  the  vaft  op- 
prefiion  of  the  precordia,1  lowers  the  pulfe,  and  is 
exceedingly  diuretic. 

Volatile  alkaline  falts,  though  likewife  antifep- 
tics  to  the  dead  fibre,  increafe  the  heat,  liquify  the 
blood,  and  promote  putrefaction  in  living  bodies. 

Emmenagogues  mufl  be  avoided.  They  heat 
and  irritate  the  patient,  and  are  never  produ&ive 
of  good. 

Camphor  has  been  held  in  great  eftimation  in 
inflammations  of  the  uterus,  in  acute  and  malig- 
L  4  nant 


CURE     OF    THE 

nant  fevers  attended  with  heat,  thirft,  watching,  de- 
lirium, and  phrenzy,  in  all  putrid  diforders,  and 
even  in  the  plague  itfelf ;  but  in  fome  conftitutions, 
when  adminiftered  in  large  dofes,  it  has  been 
known  to  produce  ftrangury,  coftivenefs,  heat, 
thirft,  fpafms,  and  even  convulfions.  * 

The  ingenious  Dr.  Alexander,  after  making  fev- 
eral  experiments  with  this  drug,  fome  of  which 
were  near  coding  him  his  life,  concludes  with  tell- 
ing us  that  he  does  not  know  whether  to  rank  it 
amongft  heating  or  cooling  medicines,  and  that  no 
certain  rule  can  be  laid  down  to  ascertain  the  ex- 
a6l  quantity  which  may  be  adminiftered  with  pro- 
priety. 


M.  Pouteau,  in  his  Melanges  de  Chirurgie, 
fpeaks  highly  of  it  in  the  puerperal  fever,  but  Doc- 
tor Denmant  fays  he  was  informed  by  a  phyflcian 

who 

*  De  Haen  (in  Hift.  Morb.  Vratifl.)  fays,  the  Phyficians  of  Breflaw  found 
that  camphor  in  the  malignant  fever  did  more  harm  than  good. 

Ratio  Medendi.  p.  150. 

t{  Does  experience  fufficiently  warrant  that  virtue  fometimes  afcribed  to 
camphor  of  preventing  a  ftrangury  ;  two  fcruples  of  it  given  to  a  woman  in 
a  clyfter,  proved  fo  irritating  as  to  bring  on  pains  refembling  thofe  of  la- 
bour. Another  woman  was  feized  with  a  ftrangury  foon  after  {he  had  taken 
a  camphor  bolus,  which  me  herfelf  imputed  to  the  camphor,  and  no  other 
probable  caufe  of  it  could  be  afllgned.  Camphor  in  its  nature  is  nearly 
allied  to  fpirit  of  turpentine,  ©ne  drachm  of  which  taken  internally  brings 
pn  a  ftrangury  as  certainly  as  cantharides." 

Med.  Tranf.  vol.  j.  p.  470,  Artt  2K  by  Dr,  Heberden, 

t  Effay  on  the  Puerperal  Fever,  p,  2, 


MILIARY     FEVER.  tfg 

who  converfed  with  him  upon  this  fubjeft,  that  he 
afterwards  altered  his  opinion.  Whenever  it  is 
thought  neceflfary  to  give  it,  I  would  advife  it  to 
be  adminiflered  in  fome  acid  vehicle,  in  lemon 
juice  as  directed  by  Hoffman,  or  in  the  julep,  e 
camphor  of  the  College,  prepared  with  vinegar  in- 
flead  of  water  in  the  manner  recommended  by 
Huxham  and  Mead,  or  with  a  fmall  quantity  of 
nitre,* 

Opiates  fhould  not  be  given  except  in  cafes  of 
great  irritation  :  They  tend  to  relax  the  patient, 
and  whenever  they  are  neceffary  they  ought  to  be 
accompanied  with  fmall  dofes  of  ipecacuanha. 

Broths,  butter,  cheefe,  eggs,  and  animal  foods  of 
all  kinds  fhould  be  avoided  as  the  encouragers  of 
putrefaction. 

Acid,  or  acidulated  liquors,  fuch  as  whey  made 
of  verjuice,  tamarinds,  or  buttermilk,  water  where- 
in 

*  Dr.  Lyfbns,  in  his  Effay  on  the  effects  of  Camphor  and  Calomel,  extols 
the  virtues  of  nitre  and  camphor  when  given  together  in  epidemic  fevers  ; 
but  many  of  the  cafes  he  has  brought  to  confirm  his  opinion  appear  to  be 
ephemeras  only,  and  might  have  gone  off  without  that  or  any  other  medi- 
cine ;  and  what  confirms  me  in  this  opinion  is,  that  he  was  often  difappoint- 
ed  in  his  expectations  from  it,  when  it  was  not  given  in  the  beginning  of  the 
fever.  [Vid.  p.  16.]  But  notwithftanding  this,  1  am  of  opinion  that  thefc 
two  medicines  are  better  given  combined  than  feparate,  as  they  correct  each 
other  ;  and  though  I  cannot  fay  pofitively,  that  I  have  feen  them  of  fervice 
;  .in  fevers,  yet  I  am  very  certain,  that  I  have  prefcribed  them,  in  the  manner 
directed  by  Mr,  Rowley,  with  very  good  effeft  to  perfons  afflifted  with  ul- 
cers of  the  legsv 


170  CURE     OF     THE 

in  current  jelly  has  been  diffolved,  lemon  and 
orangeade,  imperial,  or  Glutton's  febrifuge  julep, 
may  be  drank,  provided  they  do  not  occafion  grip- 
ings  ;  infufions  of  antifeptic  herbs,  fuch  as  camo- 
mile and  buck  bean,  bohea  and  green  tea  (if  it  has 
not  been  found  to  difagree)  thin  panada,  gruel, 
fweet  milk,  buf  te?  milk,  and  wort,  are  alfo  proper. 
If  the  bowels  be  in  too  lax  a  ftate,  rofe  leaves, 
baluftines,  or  Pomegranate  t>ark,  may  be  added  to 
the  wort.  Salep,  barley  water,  or  cold  water  with- 
out any  thing  added  to  it,  mould  be  often  given 

to  the  patient. 

• 

Where  fhe  labours  under  great  languors,  wine 
either  alone,  mixed  with  water,  or  made  into  whey, 
provided  they  are  perfectly  cold,  may  be  adminif- 
tered  occafionally  ;  if  the  patient  be  troubled  with 
the  heartburn  or  acidities  wKick  render  wine  im- 
proper, brandy  or  rum  may  be  fubflituted  in  its 
room,. 


Ipecacuanha  given  in  fmall  dofes,  fo  as  only  to 
occafion  a  gentle  puking,  is  of  great  fervice.  £$  ••' 
not  only  cleanfes  the  ftomach  of  that  glafTy  phlegm 
with  which  it  fo  much  abounds  in  this  fever,  but  is 
preventive  of  diarrheas  by  difcharging  acrid  bile, 
pancreatic  juice  or  corrupted  faliva  taken  into  the 
ftomach  by  deglutition,  or  any  other  putrid  collu- 
vies.  If  a  diarrhea  come  on  and  fink  the  patient, 
it  mufl  be  fuppreffed  or  moderated  by  aftringents, 

feich 


MILIARY    FEVER, 

fuch  as  gum,  rubr.  aftring.  lign.  campech.  fang, 
dracon.  terr.  japon.  jelly  of  Englifli  ftarch  given 
in  draughts  and  clyfterwife,  &c.  but  chalk,  abforb- 
ent  calcareous  earths,  and  the  teftacea  muft  gener- 
ally be  avoided  as  great  promoters  of  putrefaction. 
However,  when  acidities  abound  in  the  primes  i)ics^ 
which  may  be  known  by  four  eru&ations,  vomit- 
ings, or  by  green  ftools,  the  chalk  julep  with  tinc- 
ture of  bark  may  be  given  with  advantage,  and  the 
white  decoclion  may  be  drank  for  common  drink. 

Neutral  draughts  may  be  continued  through  this 
ftage  of  the  diforder,  giving  along  with  them  oc- 
cafionally  fuch  cordials  as  the  rad.  ferpent.  contray- 
erv.  and  confe6t.  cardiaca,  or  any  of  the  compound, 
waters,  according  to  the  ftrength  of  the  patient. 
The  pulv.  contrayerv.  compof.  of  the  College  is  an 
improper  medicine  in  this  fever,  as  it  contains  fo 
large  a  proportion  of  the  teftacea  as  will  overbal- 
ance the  antifeptic  powers  of  the  contrayerva  root. 
Elix.  vitriol,  dulc.  given  in  draughts,  and  moft 
preparations  of  the  bark,  beginning  with  the  {lender 
ones,  fuch  as  cold  infufions  of  it,  bark  tea,  and 
Huxham's  tin&ure,  are  of  great  fervice  in  bracing 
and  ftrengthening  the  fibres,  preventing  fweat,  and 
refilling  putrefaction.  If  the  patient's  ftomach 
will  not  bear  the  bark?  it  may  be  adminiftered  in 
clyfiers,* 

The 

*  Dr   T.  hwell  relates  the  cafe  of  a  woman  -who  had  a  fever  in  her  lyinj 
jp  v»h«i-s  tue  bark  was  of  great  fervice  given  in  clyfiers. 

£{T,  Phyf,  &  Lit.  vol.  2.  p,  418. 


CURE 


OF    THE 


The  apthae  attending  this  fever  are  generally  re- 
lieved by  the  bark,  by  acids,  and  acidulated  gar- 
gles, and  by  borax  given  in  the  form  of  a  linclus. 

The  third  or  laft  ftage  of  this  diforder  is  very 
hazardous. 

I  have  frequently  known  muflc  of  great  fervice 
in  watchings,  deliriums,  the  fubfultus  tendmum, 
hiccoughings,  and  convulfions  ;  but  it  is  often  given 
in  too  fmall  dofes  ;  and  hiccoughings  have  often 
been  relieved  by  a  few  drops  of  oil  of  cinnamon. 

If  the  patient's  pulfe  fink,  and  (he  become  le- 
thargic, blifters  and  linagifms  muft  be  applied  to 
ftimulate  and  roufe  her,  and  the  highefl  cordials, 
particularly  wine  in  confiderable  quantities,  and 
even  the  fal  c.  c.  are  neceflary  for  her  fupport. 

During  the  whole  treatment  of  the  miliary  fever 
in  puerperal  cafes,  the  greateft  circumfpe&ion  and 
delicacy  are  required.  The  patient  can  frequently 
neither  bear  to  be  raifed  nor  deprefifed.  She  can 
endure  but  few  evacuations.  Bleeding,  purging, 
and  even  bliftering,  except  as  a  flimulus  in  the 
laft  ftage  of  this  diforder,  are  hurtful.  Neither 
fudorifics  nor  diuretics  mould  be  adminiftered, 
No  animal  food,  nothing  that  is  feptic,  nothing 
weakening,  nothing  heating,  irritating  or  difTolving 

the 


MIUARY    FEVER. 

the  blood,  fhould  be  given,  except  in  the  laft  ftage. 
She  can  at  all  times  bear  gentle  vomits,  and  emoll- 
ient clyfters  to  clear  the  prime?  vice.  Pure,  free,  and 
cold  air  is  ufeful  if  it  be  let  in  by  degrees  and  ad- 
mitted cautioufly.  Cold  liquors  if  given  with  pru- 
dence a\e  beneficial,  and  too  much  ftrefs  cannot 

be  laid  upon  acid  and  aftringent  antifeptics. 

V 

All  irregular  difcharges  muft  be  reftrained,  and 
the  patient  properly  fupported.  We  muft  remem- 
ber there  is  no  particular,  and  indeed  feldom 
any  crifis  in  this  difordfcr  ;  wherever  there  is  it  is  the 
aft  of  nature,  not  of  arVjj  and  I  muft  add,  that 
critical  eruptions,  or  difchas(ges  are  fo  far  from  be- 
ing prevented  by  cold  a*r  or  cold  liquors,  that  they 
are  promoted  by  them*.  The  nearer  the  heat  of 
the  body  is  brought  to  the  ftandard  of  health,  the 
fooner  and  the  eafier  will  nature  be  enabled  to 
throw  off  her  burden; 

CASES. 

*  "  Several  patients  labouring  under  eruptive  fevers,  who  have  happened 
to  keep  out  of  bed  a  little  time  every  day  for  feveral  days  together,  have 
conftantly  found  that  the  eruption  was  greater  while  they  were  up  and  cool, 
and  th^t'  it  began  to  fade  as  foon  as  they  were  hot  in  bed.  ,t  Is  it  owing  to 
1  experience  or  hypothefis  that  eruptions  ar,e  believed  to  be  thrown  out  more 
vigoroufly  by  warmth  and  lying  in  bed  ?" 

Queries  by  Dr.  Heberden,  Med.  Tranf,  vol.  i.  p.  470? 


6  A  S  E 


CASES 


CASE 


L 


ANUARY  14th,  1761.  Betty  Rigg, 
aged  2 1 ,  died  in  the  Mancheiler  in* 
firmary  of  aperipneumony  after  three 
or  four  days  illnefs,  being  about  fix 
months  gone  with  child,  and  I  had 
an  opportunity  of  infpe6Hng  the  body.  The  tho- 
rax contained  a  good  deal  of  water,  and  the  right 
lobe  of  the  lungs  was  mortified,  the  womb  and  the 
reft  of  the  vifcera  appeared  to  be  in  a  found  and 
^natural  ftate.  The  womb  was  contiguous  to  the 
peritoneum,  the  inteftines  chiefly  occupying  the 
epigailric  region,  being  fupported  by  the  diftended 
uterus.  Upon  opening  the  womb  and  difcharging 
the  waters,  I  had  a  full  view  of  the  fituation  of  the 
fetus,  which  lay  upon  its  right  fide,  the  head  to  the 
os  uteri,  the  right  ear  to  the  os  facrumj  the  left  to 
the  os  pubis,  the  breech  and  feet  to  the  fundus  ute- 


CASES. 

ri,  the  knees  drawn  up  to  the  belly,  and  the  chia 
down  to  the  breaft.  The  placenta  adhered  to  the 
anterior  part  of  the  womb.  The  womb  was  not 
much  altered  in  thicknefs  from  an  unimpregnated 
Hate.  Her  friends  coming  prevented  any  further 


examination. 


R  E  M  ARK. 

Till  within  thefe  few  years  it  has  generally  been 
imagined  that  the  fetus  from  the  time  of  concep- 
tion to  the  8th  or  9th  month,  or  even  till  the  la- 
bour began,  was  placed  in  <a  fitting  pofture  in  the 
womb,  with  the  face  to  the  mother's  belly,  and  the 
head  to  the  fundus  uteri  ;  that  at  the  8th  month 
or  later  the  head  growing  heavier  than  the  reft  of 
the  body,  and  fpecifically  heavier  than  the  fluid  in 
which  it  fwam,  turned  itfelf  dov/n  to  the  os  uteri, 
with  the  face  to  the  mother's  back,  and  remained 
there  till  the  labour  came  on,  and  was  then  forced 
forward  in  the  fame  direction. 

By  the  frequent  Inflections  of  pregnant  women, 
children  have   been   found  in   various  pofitions, 
which  has  occafioned  variety   of   opinions.     But 
the  greater  number  of  cafes,  efpecially  thofe  that 
have  been  taken  notice  of  within  thefe  few  years, 
^  feem  to  favour   the   following  opinion ;  that  the 
child  in  all  natural  cafes  from  the  time  of  concep- 
tion 


i75  CASES. 

tion  to  the  time  of  labour  lies  with  the  head  down- 
wards, the  breech  and  feet  to  the  fundus  uteri,  one 
fide  to  the  mother's  back,  and  the  other  to  the 
mother's  belly,  and  after  labour  is  come  on,  the 
child  moves  downwards  in  the  fame  direction,  with 
one  ear  to  the  os  facrum,  and  the  other  to  the  os 
pubis,  till  the  child  is  pretty  far  advanced,  when 
its  face  turns  into  the  hollow  of  the  os  facrum,  and 
the  occiput  comes  from  under  the  os  pubis  ;  and 
I  believe  this  is  always  the  cafe,  except  when  na- 
ture is  by  fome  accident  or  other  put  out  of  her 
natural  courfe.  The  form  of  the  pelvis,  the  touch- 
ing frequently  in  the  lail  months  of  pregnancy, 
and  at  different  times  of  labour,  all  feem  to  con- 
firm this. 

Though  this  is  now  the  general  do&rine  of  the 
teachers  of  midwifery,  yet  as  few  real  diffe£lions 
to  confirm  it  have  been  made  public,  I  thought  it 

might  not  be  ufelefs  to  add  one  to  the  number, 
i 

.CASE      II. 

IVlRS. was  delivered  upon    the 

2ift  of  April,  1770,  of  her  third  child.  Her  habit 
of  body  was  delicate.  She  was  very  fubje6l  to 
nervous  diforders,  had  been  accuftomed  to  warmth, 
and  had  all  her  life  been  treated  with  the  greatefl  ten- 
dernefs.  She  had  a  good  natural  labour,  and  the 

placenta 


CASES.  177 

placenta  came  away  without  difficulty.  Several 
days  elapfed  before  me  made  any  complaints,  but 
1  obferved  when  I  vifited  her  that  £he  was  always 
in  a  fweat.  There  was  a  large  fire  in  the  room 
which  made  it  very  hot,  and  there  was  a  difagreea- 
ble  fmell  in  it.  Her  lochia  were  in  proper  quan- 
tity, but  very  offenfive. 

I  repeatedly  defired  that  me  might  be  kept  cool, 
that  a  little  frefh  air  might  be  frequently  admitted, 
and  ordered  her  to  be  got  up  every  day  ;  but  none 
of  thefe  directions  were  complied  with. 

On  the  5th  day  (he  had  feveral  loofe  ftools  with 
flight  pains  in  the  abdomen,  her  tongue  was  whit- 
ifh,  her  pulfe  rather  too  quick,  me  was  troubled 
with  the  heartburn  and  had  four  eructations,  and 
continued  fweating.  As  her  complaints  were  trif- 
ling, I  only  prefcribed  four  large  fpoonfuls  of  the 
chalk  julep  to  be  taken  every  four  hours,  and  or- 
dered her  the  white  deco&ion  for  common  drinjc. 
In  the  evening  the  diarrhea  and  pains  in  her  bel- 
ly increafed,  fhe  feemed  eafier  however  after  every 
ftool,  and  was  directed  to  take  three  fpoonfuls  of 
Fracaftorius's  decoction  every  three  hours. 

./ 
Day  the  6th.     Her  loofeuefs  was  abated  and  fhe 

feemed  better, 

M  On 


CASE  S. 
On  the  7th,  Her  fweats  continued,  the  diar- 
rhea increafed,  and  her  pains  returned.  Her  ftoois 
were  fo  very  frequent,  that  I  thought  it  neceflary 
to  check  them  by  a  clyfter  of  the  chalk  julep  in 
which  two  grains  of  opium  had  been  diffolved.  In 
the  evening  her  pains  and  loofenefs  were, much 
worfe,  and  me  complained  of  a  cough.  She  wasov- 
dered  an  oily  draught,  with  twenty  drops  of  liquid 
laudanum,  and  a  mixture  made  with  the  jelly  of 
ilarch,  of  which  {he  was  directed  to  take  three  large 
fpoonfuls  after  every  loofe  ftool. 

On  the  8th.  Her  pulfe  beat  120  times  in  a  min- 
ute :  her  tongue  had  a  white  fur  upon  it,  her  milk 
decreafed,  herlochia  flopped,  and  ihe  had  eighteen 
or  twenty  ftoois.  Her  fweat  and  ftoois  were  fo 
extremely  putrid  as  to  be  offenfive  not  only  tothofe 
in  the  room,  but  to  the  whole  houfe.  No  argu- 
ments could  prevail  upon  her  attendants  to  admit 
frefh  air.  A  clyfter  was  adminiftered  compofed  of 
the  jelly  or  ftarch,  and  half  an  ounce  of  diafcordi- 
um.  Draughts  confiding  of  jelly  of  ftarch,  a  fcru- 
ple  of  the  cordial  confection,  and  a  drachm  of  the 
fyrup  of  poppies  were  given  her  every  four  hours. 
In  the  evening  fhe  took  a  draught  with  ten  grains 
of  rhubarb  in  it. 

'On  the  pth.  Continued  much  the  fame.  On 
the  loth  her  tongue  had  contracted  a  thick  fur; 
her  pulfe  beat  120  times  in  a  minute,  her  milk  was 

much 


CASES.  179 

much  decreafed,  her  fweats  and  loofenefs  continu- 
ed. My  worthy  and  learned  friend  Dr.  Brown  was 
joined  in  confultation  with  me.  We  ordered  her 
two  grains  of  ipecacuanha  in  a  little  mint  water, 
which  procured  her  one  gentle  puke.  Draughts 
containing  ten  grains  of  the  compound  powder  of 
bole,  a  fcruple  of  the  cordial  confection,  and  five 
grains  of  nitre,  were  given  her  every  fix  hours.  In 
the  evening  the  pains  in  her  abdomen  were  fo  great 
that  me  was  obliged  to  take  a  grain  of  the  Theban 
extract. 

Day  nth.  She  remained  much  the  fame*  The 
draughts  were  continued. 

Day  12th.  Very  little  alteration.  The  draughts 
continued. 

On  the  i4th.  The  diarrhea,  fweats,  quick  pulfe 
and  white  tongue,  as  in  the  four  preceding  days. 
The  pains  in  her  belly  as  bad  as  ever.  The  nitre 
was  omitted,  and  forty  drops  of  the  Paregoric  elix- 
ir were  added  to  each  draught.  There  was  little 
alteration  either  in  her  iymptoms  or  her  medicines 
till  her  igth  day,  when  me  feemed  to  be  worfe 
than  ever,  and  complained  much  of  a  weight  and 
oppreflion  about  her  breaft  and  ftomach* 

Being  both  alarmed  and  furprifed  at  tlfc  obftina* 
cy  of  her  cafe,  we  talked  with  her  hufband  about 
M  2  it. 


CASE  S. 
it.  He  informed  us  that  her  mother,  and  another 
lady,  with  the  nurfe  and  child,  had  conftantly 
lain  in  the  fame  room  with  her  fince  her  delivery, 
that  our  dire&ions  in  regard  to  air  and  ventilation 
had  never  been  complied  with,  and  that  if  we  had 
opened  a  door,  it  was  fhut  immediately  after  our 
leaving  the  houfe.  That  a  large  fire  had  been  kept 
in  the  room  day  and  night,  that  the  curtains  had 
been  always  drawn  clofe  round  her  bed,  and  that 
fhe  had  not  been  permitted  to  breathe  any  air  but 
what  had  been  polluted  by  her  fweat  and  excre- 
ments, and  the  effluvia  arifing  from  the  breath  of 
fo  many  perfons.  That  feveral  of  thofe  who  were 
mofl  with  her  had  got  the  fame  kindof  putrid  dia  rrhea, 
but  that  he  had  himfelf  efcaped  it,  mofl  probably 
becaufe  he  had  avoided  as  much  as  poflible  going 
into  the  room,  upon  account  of  the  exceflive  heat, 
and  offenfive  fmell  which  it  afforded.  He  faid  he 
was  now  fenfible  both  of  the  danger  me  was  in,  and 
of  the  abfurdity  of  the  practice  of  thofe  about  her, 
and  that  he  was  therefore  determined  to  fee  our  di- 
rcdlions  flri&ly  complied  with.  The  fire  was  tak- 
en out  of  the  rpom,  which  was  gradually  cooled, 
and  thoroughly  ventilated  by  frequently  opening 
the  door  and  window.  Eight  grains  of  rhubaib 
were  given  her  in  a  folution  of  fpermaceti. 

The  next  morning  me  was   confiderably  better  ; 
her  pulfe,  which  for  many  days  had  never  beat  lefs 
i2O,  beat  now  #o  more   than   100  times 

in 


CASES.  184 

In  a  minute,  and  her  urine  depofited  a  fedimenfr. 
The  ipecacuanha  was  repeated. 

On  the  sift.  Thelochia  returned,  and  her  loofe- 
nefs  was  more  moderate  :  me  was  directed  to  take 
two  fpoonfuls  of  Huxham's  tincture  of  bark  every 
eight  hours.  The  room  was  fprinkled  with  vine- 
gar, and  the  ipecacuanha  repeated* 

The  22d.  The  ipecacuanha  having  puked  her 
gently,  relieved  her  breaft  and  ftomach,  and  was 
therefore  repeated.  She  was  coniiderably  better, 
was  removed  into  another  room,  and  our  directions 
were  punctually  complied  with. 

The  23d.  Her  milk  was  entirely  gone,  her 
loofenefs  very  moderate,  and  the  ipecacuanha  was 
repeated. 

The  24th  and  25th.     The  ipecacuanha  repeated* 
The  26th.     She  was  very  cool. 


On  the  27th,  She  took  a  draught  containing 
ten  grains  of  the  powder  of  rhubarb,  and  the  fame 
quantity  of  compound  powder  of  bole;  her  pulfe 
was  reduced  fo  as  only  to  beat  eighty  times  in  & 
minute,  and  me  had  no  complaint,  but  that  of  want 
of  ftrength,  for  which  {he  was  ordered  a  decoftion 
M  3  of 


182  CASES. 

of  the  bark  with  Huxham's  tin&ure,  and  the  com- 
pound powder  of  bole.  In  a  little  while  fhe  per- 
fectly recovered  her  ftrength,  and  has  had  another 
child  fmce.  During  her  Lift  lying  in,  fhe  ftri&ly 
obferved  the  directions  I  gave,  and  had  no  fever, 
or  other  bad  fymptoms. 

* 
CASE      III. 

MRS.  — — ,  a  ftrong,  lufty,  healthy 
woman,  was  delivered  on  the  fourth  of  May,  1770, 
of  a  fine  large  child.  She  had  a  natural  labour, 
and  the  fecundines  came  away  very  eafily.  This 
was  her  fourth  lying  in. 

Her  room  was  clofe  and  fmall,  a  large  fire, 
which  had  been  kept  in  it  conflantly,  render- 
ed it  very  warm. — Every  time  I  vifited  her  I  found 
her  in  fweats.  I  frequently  defired  that  the  room 
might  be  kept  cooler  and  more  air  admitted  into 
it,  but  this  was  not  complied  with. 

3  •  stf 

The  lochia  were  in  proper  quantity,  but  fo  of- 
fenfive  as  to  affect  the  whole  room. 

She  made  no  particular  complaints  till  the  fifth 
day  in  the  morning,  reckoning  from  the  day  of  her 
delivery,  when  me  was  feized  with  violent  pains, 
attended  with  a  forenefs,  fwelling  and  tenfion  of 

the 


CASES.  iSg 

the  abdomen,  accompanied  with  a  tenefmus,  the 
motions  of  which,  though  frequent  and  very  pain- 
ful, occafioned  her  to  void  very  little,  excepfrnu- 
cus.  Her  pulfe  was  quick,  her  tongue  white,  and 
burning  heats  now  came  on,  fucceeded  by  fweat- 
ings.  She  complained  of  pains  in  her  head,  back, 
and  loins.  I  directed  emollient  clyfters  to  be  ad- 
miniftered  every  half  hour,  which  procured  her 
eafe  and  copious  ftools.  She  laboured  likewife  un- 
der naufea,  retchings,  and  vomitings.  The  apoth- 
ecary was  directed  to  give  her  a  vomit  of  a  fcruple 
of  ipecacuanha  in  a  draught,  and  to  work  it  off  with 
an  infufion  of  camomile,  and  I  defired  her  to  fit 
up  often  in  bed,  and  to  get  out  of  it  once  every  day. 
On  the  fixj£p  day  me  had  feveral  difcharges  by 
flool,  and  after  every  ftool  feemed  fomething  eafier. 
In  other  refpedh  me  w"as  no  better.  Her  lochia  flop- 
ped, and  her  milk  abated  in  quantity.  I  ordered 
the  fire  to  betaken  out,  thedoonto  be  thrown  back^ 
and  a  window  tp.  an  adjoining  roofh  to  be  keptcori- 
ftantly  open,  anxll  vifited  her  frequently,  and  faw 
that  this  was  really  done.  She  was  taken  out  of 
bed  whilft  clean  meets  were  laid  on,  and  five  grains 
of  the  calx  of  antimony,  tand  half  a  grain  of  emetic 
tartar  were  given  her  three  times  a  day. 

On  the  7th  day  the  window  and  door  were  con- 
tinued open,  and  a  free  circulation  of  the  air  was 
brought  on  by  opening  the  window  of  the  room  irt 
which  fhe  lay,     The  calx  of  antimony  and  emetic 
M  4 


184  CASES, 

tartar  were  continued.  She  had  plenty  of  flools, 
was  much  cooler,  her  fweatings  were  abated,  and 
her  pains  fomething  better.  On  the  8th  day,  all 
her  complaints  were  gone  ;  her  milk  and  lochia 
returned,  and  fhe  removed  into  another  room. 

CASE      IV. 

JANUARY  i2th,  1771.    At  two 

o'clock  in  the  morning,  Mrs. was  delivered 

of  a  fine  child,  without  any  afliftance;  the  navel 
firing  was  torn  off  clofe  to  the  placenta,  and  did 
not  bleed.  I  faw  her  about  half  an  hour  af- 
ter the  child  was  born,  the  placenta  was  expelled 
from  the  womb  by  her  natural  pains  only,  and  I 
had  nothing  to  do  but  take  it  from  her.  After 
the  child  had  been  born  about  an  hour,  I  cut  the 
navel  firing  about  four  inches  from  the  child's  bo- 
dy, 'and  it  did  not  bleed.  Her  labour  being  much 
quicker  this  time  than  it  had  been  of  her  former 
children,  fhe  was  unprepared  for  it.  The  night 
was  exceedingly  cold,  being  a  very  fevere  froft  ; 
the  fire  was  almoft  out ;  fhe  was  jufl  got  out  of  bed, 
with  only  half  her  clothes  on,  when  the  waters 
broke,  and  the  child  was  born ;  the  nurfe  did  not 
get  to  her  till  fome  time  after  I  was  there,  fo  that 
fhe  fat  about  an  hour  in  a  very  cold  wet  condition ; 
add  to  this,  that  fhe  had  at  that  time  a  very  bad 
cold  upon  her.  After  fhe  was  put  to  bed,  fhe  did 

not 


CASES.  185 

not  get  warm  in  feveral  hours,  though  a  large  fire 
was  made,  great  quantities  of  clothes  were  heaped 
upon  her,  warm  liquors  were  given  her  to  drink, 
and  her  feet  were  wrapped  in  warm  flannel.  I  faw- 
ner in  the  evening  following,  and  found  her  much 
too  warm,  fweating,  with  a  quick  pulfe,  and  com* 
plaining  of  pains  in  her  belly.  I  defired  the  fire 
might  be  leffened,  andfomeof  the  clothes  taken  off, 
but  it  was  not  complied  with.  I  faw  her  the  next 
day,  and  repeated  the  fame  advice,  but  with  no 
better  effect.  I  faw  her  upon  the  third  day  when 
fhe  was  flill  too  hot,  and  fweating,  and  her  pulfe 
too  quick  :  fhe  got  up  in  the  evening,  and  had  a 
coflive  (lool ;  fhe  had  currants  given  in  her  gruel, 
and  eat  fome  flewed  prunes.  She  now  complain- 
ed of  cold  chills  running  over  her.  Upon  the 
fourth  day,  fhe  complained  of  flight  cold  fhiverings, 
fucceeded  by  heats,  and  had  a  coftive  flool.  On 
the  fifth  day,  the  cold  fhiverings  were  more  fevere; 
(he  complained  of  a  pain  in  her  back,  and  had  two 
loofe  ftools,  with  griping  pains  in  her  bowels  ;  the 
flools  were  very  hot  and  fharp.  I  ordered  her  half  a 
grain  of  emetic  tartar  to  be  taken  twice  a  day,  which 
did  not  puke  her.  The  loofenefs  increafed  very 
much  on  the  fixth  day  ;  fhe  had  a  flool  every  five 
minutes.  I  ordered  her  twenty  five  grains  of  ipecacu- 
anha, which  vomited  her,  and  brought  up  a  large 
quantity  of  phlegm  and  bile.  My  directions  were 
now  pretty  fiddly  complied  with,  feveral  clothes 
were  taken  off  the  bed,  the  fire  was  leffened,  the 

room 


l86  CASES. 

room  was  kept  more  cool,  and  the  door  often  open- 
ed to  renew  the  air,  and  {he  got  out  of  bed  every 
day.     The  lochia  were  very  pale,  and  the  milk  did 
not  flow  into  her  breads    in    proper   quantities, 
though  the  child  was  laid  to  them  often  in  the  day. 
I  ordered  the  decoct,   alb.  for  common  drink,  and 
by  her  own  defire  fhe  eat  fome  boiled  horfe  beans, 
which  remedy  had  formerly  been  of  fervice  to  her  in 
a  loofenefs;  Ihe  alfo  drank    fome  of  the  water  in 
which  the  beans  had  been  boiled.     She  had  a  very 
crood  night,  without  any  flool,  but  on  the  feventh 
in  the  morning,  had  a  dozen  ftools ;  me  was  now 
perfectly  cool,  and  the  pulfe  quite  calm.     As  fhe 
complained  of  being  faint  and  weak,  I  ordered  her 
the  julep,  e  creta,  with  a  drachm  of  confe6l.  car- 
diac, to  be  taken  as  often  as  fhe  found  it  neceflary, 
and  now  and  then  a  little  brandy  and  water.     On 
the  eighth  day  Ihe  had  two  or    three    ftools ,  but 
made  no  other  complaint,  except  that  of  weakaefs ; 
her  milk  began  to  be  more  plentiful,  and  fhe  had  a 
very  good  night.     On  the  ninth  day,  about  noon, 
I  vifited  her,  and  found  her  perfectly  well,  having 
no  flool  either  in  the  night,  or  that  morning,  and 
her  milk  now  flowed  in  a  proper  quantity. 

CASE      V, 

ELLEN  RAVENSCROFT,  a  poor 

woman,  twenty  five  years  of  age,  near  fix  months 

gone  with  child,  was,  upon  Friday  the  goth  of  Au- 

guft, 


CASES.  187 

guft,  177!)  feized  with  pains  in  her  head  and  back 
attended  with  a  rigour.  She  complained  much  of 
cold  :  white  wine  whey  was  given  to  bring  on 
a  fweating,  which  enfued  profufely  ;  me  was  kept 
in  bed,  and  bliilers  were  applied  behind  her  ears. 

Monday,  Sept.  2d.  She  this  day  took  two  dofes, 
confiiling  each  of  half  a  grain  of  emetic  tartar, 
and  five  grains  of  the  calx  of  antimony, 

Sept.  3d.  The  fame  dofe  repeated  :  She  likewifc 
took  two  ounces  of  the  camphor  julep,  with  ten 
grains  of  nitre,  and  in  lefs  than  half  an  hour  after 
grew  delirious. 

Wednefday,  Sep.  4th,  the  fixth  day  of  her  fever. 
I  faw  her  this  day,  for  the  firft  time  ;  (he  was  con- 
fined to  her  bed  in  a  fmall  room  which  was  very 
hot  and  clofe,  and  fmelt  very  difagreeably.  She 
complained  of  pains  in  her  head,  back,  and  fide  of 
her  belly ;  her  tongue  was  brown  and  dry,  her  pulfe 
quick  and  fmall,  her  urine  flame  coloured,  and  me 
had  a  plentiful  eruption  of  red  miliary  puflules, 
particularly  upon  her  breaft,  the  infides  of  her 
arms,  betwixt  her  fingers,  and  upon  fuch  parts  of 
her  body  as  had  fweated  the  moft  plentifully.  She 
was  deliriousj  and  had  a  fubfultus  tendinum.  The 
£htimoniai  powders  had  procured  no  confid- 

erable 


i88  C    A    S    E    S.  > 

crable  effe&.  I  gave  her  ten  grains  of  ipecacuanha, 
which  vomited  her  very  well,  and  brought  up  a 
great  deal  of  glaffy  phlegm.  A  blifter  was  applied 
between  her  fhoulders ;  (lie  was  ordered  to  drink 
milk  and  water,  cold  water,  or  buttermilk  and  wa- 
ter, plentifully ;  fhe  fometimes  took  water  gruel  and 
barley  water;  a  window  was  kept  open  during  the 
day  time,  and  a  clyiler  was  given  her. 

Friday  the  8th  of  the  fever.  The  blifter  was 
ordered  to  be  taken  off,  and  the  part  was  warned 
with  milk  and  water  to  prevent  a  ftrangury.  She 
was  delirious,  the  miliary  eruption  was  dying  away, 
and  another  vomit  was  given  her.  Upon  this,  and 
the  fucceeding  days  tfee  window  was  opened,  and 
the  clyfler  was  daily  repeated. 

Saturday  the  gth.      No  alteration  appeared. 

Sunday  the  loth  day.  She  had  frequent  retch- 
ings to  vomit,  attended  with  flight  labour  pains, 
and  took  every  three  hours  a  fcruple  of  fait  of  worm- 
wood in  half  an  ounce  of  lemon  juice  during  the 
a6l  of  effervefcence,  which  was  mixed  clofe  under 
her  mouth,  that  fhe  might  breathe  the  fixed  air. 

Monday,  Sept.  gth,  the  eleventh  of  her  illnefs. 
She  this  day  mifcarned  in  the  beginning  of  the 
feventh  month  of  her  pregnancy. 

Tuefday, 


CASES, 

Tuefday.  She  flill  remained  delirious,  the  fub- 
fultus  tendinum  continued,  her  tongue  was  covered 
witk  a  brownifh  fur,  her  urine  was  flame  coloured, 
her  pulfe  was  quick  and  fmall,  her  fkin  was  dry 
and  parched,  and  the  difcharge  of  the  lochia  was 
trifling.  The  window  and  door  were  now  ordered 
to  be  kept  open  day  and  night.  She  was  raifed 
up  in  bed  as  often  as  (he  could  be  prevailed  upon, 
drank  nothing  but  what  was  cold,  and  took  every 
three  hours  fait  of  wormwood  and  lemon  juice 
during  the  a 61  of  effervefcence.  The  vomit  and 
clyfter  this  day  repeated. 

Wednefday.  The  difcharge  of  the  lochia  was 
very  fmall,  fhe  had  no  appearance  of  milk,  but 
feemed  fomething  better. 

Thurfday.     Much  better,  very  fenfible,  but  deaf, 
Friday,  Sept.  13th.     No  material  alteration. 

Saturday.  Her  fituation  much  like  that  of  the 
two  preceding  days  ;  the  clyfter  repeated,  the  lemn 
on  juice  and  fait  of  wormwood  continued,  and  her 
drink  buttermilk  and  water,  &c.  as  before.  The 
door  and  window  ftill  kept  open. 

Sunday,  Sept.  15th.     She  remained  in  the  fame  ] 
flate  till  evening,  when  fhe  began  to  be  a  little  de- 
lirious* 


ig©  CASES. 

lirious.  The  night  was  frofty,  but  the  door  and 
window  were  ftill  kept  open. 

•» 
Monday,  i6th,  the  i8th  day  of  the  fever,  and 

the  8th  from  her  delivery.  I  this  morning  found 
upon  her  a  plentiful  eruption,  which  was  evidently 
not  of  the  miliary  kind.  The  puftules  were  as 
large  as  peas,  perfectly  diuincl;,  but  not  pellucid, 
and  mod  nearly  refembled  thofe  eruptions  which 
are  commonly  termed  fcorbutic.  They  were  chief- 
ly upon  her  legs  and  the  out  fides  of  her  arms, 
though  (he  lay  conftantly  with  her  arms  out  of  bed, 
and  expofed  them  as  much  as  poflible  to  the  cold 
air  of  the  window,  clofe  to  which  the  bed  was 
placed;  none  of  them  appeared  upon  her  body. 
This  eruption  was  attended  with  a  violent  itching 
in  the  (kin.  Her  tongue  was  moift,  but  had  a 
whitifh  fur  upon  it  :  She  took  another  vomit,  and 
parted  with  a  great  quantity  of  glaffy  phlegm.  The 
night  was  very  rainy,  and  the  window  continued 
open. 

Tuefday,  ijth.  The  puftules  were  more  numer- 
ous, and  had  run  together.  She  was  quite  fenfible, 
but  deaf ;  her  pulfe  regular,  her  tongue  moift  but 
while,  her  urine  of  a  natural  colour,  with  little  or 
no  fediment ;  fhe  complained  of  a  flight  forenefs 
In  her  breads,  but  there  was  no  milk  in  them. 

Wednefday 


CASES,  igt 

Wednefday  the  i8th.  This  fecond  eruption  was 
dying  away,  her  pulfe  was  flow  and  regular,  her 
tongue  moift,  the  itching  in  her  fkin  continued. 

Thurfday.     She  continued  to  recover. 

Friday,  September  2Oth,  the  22d  from  the 
commencement  of  the  fever,  and  the  i2th  from  her 
mifcarriage.  She  had  no  complaints,  except  thofe 
of  weaknefs,  and  of  an  itching  which  the  eruption 

had  left  behind  it. 

/ 

' 

In  this  cafe  it  is  worthy  of  obfervation  that  there 
were  two  eruptions,  totally  differing  from  each 
other  ;  the  fir  ft  what  is  generally  called  the  red 
miliary,  and  by  fome  a  ram,  evidently  produced 
by  profufe  fweating,  and  in  the  greateft  quantity 
upon  thofe  parts  of  the  body  which  were  kept  the 
warmeft  ;  the  other  of  a  much  larger  kind,  attend- 
ed with  violent  itchings,  came  out  upon  thecoldeft 
parts  of  her  body,  when  fhe  had  been  twelve  en- 
tire days  without  fweating,  after  a  frofty  night,  in 
which  the  window  had  been  kept  conftantly  open. 
This  eruption,  though  it  had  all  the  appearance  of 
being  critical,  for  the  fever  feemed  to  have  no  other 
crifis,  was  not  at  all  checked  by  the  cold  air,  or 
wet  night,  which  fucceeded  its  appearance. 

Upon 


CASES. 

Upon  the  whole,  I  think  this  cafe  helps  to  prove 
tbat  ei-uptions  of  the  miliary  kind  are  promoted 
by  fweating,  that  they  are  not  critical,  that  cold  air 
and  cold  water  are  afllflant  in  fupprefling  them, 
and  that  cold  air  and  cold  water  will  not  prevent 
eruptions  of  a  more  critical  nature. 

N.  B.  Upon  inquiring  of  her,  fmce  (he  recover- 
ed, (he  informs  me  that  fhe  does  not  recollect  the 
leaft  circumftance  about  her  mifcarriage. 

CASE     vr. 

r-pi 

IHE  fubjeS;  of  the  following  article 
is  a  lady  of  an  extremely  tender  conftitution.  Her 
appetite  is  bad,  flie  fleeps  ill,  and  has  during  the 
greateft  part  of  her  life  been  fubje£l  to  frequent 
returns  of  the  bilious  cholic,  with  fevers  and  diar- 
rheas attended  with  an  univerfal  yellownefs  of  the 
flun,  and  pains  in  her  right  fide.  Thefe  complaints 
have  prevented  her  taking  that  exercife  which  was 
neceffary,  and  for  many  years  have  rendered  her 
incapable  of  riding  on  horfeback.  She  was  always 
fo  impatient  of  cold  when  in  perfect  health,  as  to 
require  a  fire  during  the  heats  of  fummer. 

She  had  borne  feven  children ;  five  of  her  labours 
were  natural,  and  two  of  them  preternatural.  To 

*     fix 


CASES. 

fix  of  her  children  fhe  had  been  herfelf  a  nurfe. 
During  thefe  lyings  in  file  never  was  once  in  a 
fweat,  nor  was  fhe  troubled  with  the  flighteft  fever- 
ifh  fymptom.  In  the  firft  week  fhe  feldom  got 
much  deep.  This,  together  with  a  poor  appetite, 
prevented  her  gaining  ftrength  fo  faft  as  many 
others  do,  but  fhe  was  generally  down  itairs  at  the 
termination  of  the  month. 

She  was  continually  hot  and  feverifh  for  feveral 
weeks  at  the  latter  end  of  pregnancy  of  her  eighth 
child,  and  during  that  time  was  frequently  troubled 
with  falfe  pains. 

- 

On  the  23d  of  Augufl,  1771?  fhe  received  a 
fright  as  fhe  was  riding  in  her  chariot,  and  ori 
Sunday  the  25th  was  feized  with  a  mivering  fit, 
and  was  fo  extremely  cold  that  fhe  was  obliged  to 
order  a  large  fire  to  be  made  in  her  chamber.  In 
this  ftate  fhe  continued  the  greater  part  of  the  day. 
About  five  o'clock  in  the  afternoon  fhe  began  to 
flood,  her  falfe  pains  continued,  fhe  was  much 
alarmed,  and  as  yet  there  feemed  to  be  no  prepara- 
tion for  labour,  fhe  now  took  twenty  drops  of  the 
Theban  tin&ure,  with  as  many  of  the  acid  elixir 
of  vitriol.  In  a  little  while  the  mouth  of  the" 
womb  began  to  dilate,  and  the  child  might  be  per- 
ceived to  be  in  a  natural  petition.  Her  legs  and. 
N  feet 


« 

194  CASES. 

feet  flill  continued  cold,  but  as  her  labour  advanc- 
ed her  flooding  abated,  and  fhe  grew  gradually 
warmer.  After  the  cold  fit  came  on  fhe  never  per- 
ceived the  child  to  move,  though  before  that  time 
it  had  been  remarkably  a&ive. 

About  ten  o'clock  the  fame  evening  fhe  was  de- 
livered of  a  fmall  boy.  In  lefs  than  a  minute  af- 
ter the  head  was  expelled,  another  pain  came  on, 
and  the  whole  child  was  produced  in  the  manner 
I  have  before  defcribed,  one  moulder  coming  from 
under  the  pubis,  and  the  other  pafling  along  the 
facrum. 

The  infant  did  not  cry,  it  fcarcely  ftirred,  but 
the  pulfation  in  the  navel  firing  was  very  flrong. 
Before  I  cut  it  I  waited  to  give  the  child  time  to 
recover.  In  about  five  or  fix  minutes  the  pulfa- 
tion flopped.  I  divided  the  umbilical  chord  with 
a  pair  of  fciffars,  and  the  child  gradually  recover- 
ed. No  effufion  of  blood  followed  the  divifion, 
though  I  did  not  make  a  ligature  till  fome  time  af- 
ter the  child  was  feparated  from  its  mother.  I 
thought  it  however  prudent  to  make  one  before  the 
child  was  dreffed,  left  the  warmth  of  the  clothes 
might  occafion  it  to  bleed. 

As  foon  as  the  child  was  removed  the  fecundines 
came  away  without  any  affiftance, 

The 


CASES.  i95 

The  firft  night  my  patient  got  no  fleep.  Though 
there  was  no  fire  in  the  room,  me  was  too  hot  the 
morning  following.  She  complained  of  pains  in 
her  head,  betwixt  her  moulders,  and  of  a  general 
laflitude,  but  had  no  afterpains. 

The  child  was  laid  to  her  breafts  early  the  next 
morning.  She  fat  up  feveral  times  in  bed.  In 
the  evening  fhe  was  removed  to  her  chair,  whilft  her 
bed  was  made,  and  clean  linen  laid  upon  it.  Her 
own  linen  too  was  changed.  The  chimney  was 
never  flopped,  and  the  door  was  opened  to  let 
more  air  into  the  room.  She  drank  barley  water, 
eat  toaft  and  butter,  and  a  few  plumbs  and  apri- 
cots. The  fecond  night  fhe  had  very  little  fleep. 
On  the  third  day,  Tuefday,  fhe  continued  hot  and 
thirfty.  Her  pulfe  was  too  quick.  The  noife  of 
company  in  the  houfe,  and  of  carriages  in  the 
ftreet,  diflurbed  her.  She  frequently  fell  into  pro- 
fufe  fweats.  Her  fpirits  were  low,  and  fhe  was 
much  troubled  with  flartings  and  twitchings  all 
over  her  body.  She  ate  a  little  chicken  and  French 
beans  at  dinner.  Her  drink  was  imperial,  aired 
with  a  piece  of  toafted  bread  ;  and  a  window  and 
a  door  were  opened  in  an  adjoining  clofet. 

The  third  night  fhe  was   alrnoft   fleeplefs ;  and 
on  the  fourth  day,  Wednefday,  fhe  remained  hot 
N  *  with 


,,;. 

sg£  CASES, 

with  pains  in  the  head,  back,  loins,  ftomach,  in  the 
right  fide,  and  in  the  left  moulder.  She  had  fre- 
quent ftartings,  and  broke  out  into  fweats,  and  her 
urine  was  turbid  and  high  coloured.  From  thefe 
fymptoms  I  was  apprehenfive  of  the  bilious  colic, 
but  was  unwilling  to  diflurb  the  acrid  putrid  bile 
by  either  vomits  or  purges,  choofing  rather  if  pof- 
lible  to  correcl  it  by  fruit  and  acids,  and  to  ex- 
tinguifh  the  fever  by  cold  air  and  cold  liquors.  A 
clyfter  was  however  given  her,  which  procured  a 
ftool.  The  door  into  a  gallery  was  opened,  and 
another  window  there  was  thrown  open.  A  ftuff 
quilt  which  lay  upon  the  bed  was  exchanged  for  a 
flight  w;ifhing  one.  She  was  taken  out  of  bed  and 
ftaid  up  an  hour.  Her  ufual  liquor  was  cold  im- 
perial, fhe  eat  dry  bread,  with  plumbs,  pears,  and 
grapes,  and  drank  two  cups  of  coffee  and  one  of 
tea  morning  and  evening. 

On  the  fourth  night  fhe  flept  ill. 

On  Tuefday  the  fifth  day  fhe  had  flufhings  in 
her  face,  and  her  other  fymptoms  remained  much 
the  fame' as  in  the  preceding  days.  The  doors  and 
windows  were  kept  open.  Another  clyfter  was 
given  with  fuccefs.  Her  diet  was  the  fame  as  the 
day  before,  with  the  addition  of  about  half  a 


About 

* 


CASES, 

About  midnight,  being  very  hot  and  reftlefs,  {he 
ordered  the  fervant  to  open  a  window  of  the  room 
in  which  ihe  lay.  The  remaining  part  of  the  night 
and  all  the  next  day,  this  window,  together  with 
thofe  in  the  clofet  and  gallery,  and  the  doors  which 
communicated  with  thofe  apartments,  remained 
open.  The  curtains  of  the  bed  and  windows  were 
undrawn.  There  was  a  current  of  air  through  the 
room,  and  only  a  flight  quilt  with  one  blanket  re- 
mained upon  the  bed. 

My  patient's  drefs  was  a  half  fhirt  and  a  thin 
linen  fkirt.  She  had  no  bedgown  or  waiilcoat  on, 
except  when  {he  fat  up. 

On  Friday  the  fixth  day  {he  had  a  ftool  natural- 
ly, and  me  feemed  cooler  and  better.  Her  diet  had 
not1  been  much  varied  for  feveral  days.  She  had 
coffee  twice  a  day  with  toaft  and  butter,  puddings 
and  fruit  dumplings  to  dinner,  and  bread  dipped  in 
imperial  for  fupper.  She  was  ufually  three  hours 
out  of  bed,  often  fat  up  in  bed,  and  drank  cold  im- 
perial, and  eat  fruit  plentifully  whenever  it  was 
agreeable  to  her. 


On  the  feventh  day,  Saturday,  {he  continued  bet- 
ter.    She  had  a  ftool   procure*,  by  clyfter.     She 
fat  up  four  hours,  had  free  air  and  the  ufual  diet, 
and  this  night  hejr  fleep  was  a  little  more  frieudly. 
N  3 


** 

198  CASES. 

On  Sunday  the  eighth  day  (he  was  much  cooler, 
and  in  all  refpefts  better.  She  had  a  flool  by  the 
afliftance  of  a  clyfter.  She  fat  up  five  hours,  and 
no  alteration  was  made  in  her  diet.  This  evening 
all  the  windows  and  doors  were  ihut  for  the  firft 
time.  She  had  a  good  night,  and  on  Monday  the 
ninth  day  all  her  complaints  were  vanifhed.  She 
got  up  before  dinner  and  ate  a  whole  partridge,  a 
very  unufual  quantity  for  her  when  even  in  the  bell 
ftate  of  health. 

During  this  whole  time  her  lochia  were  in  prop- 
er quantities.  Her  milk  though  not  fo  much  as 
upon  former  occafions,  was  more  than  fufficient 
for  the  child  ;  on  the  fourth  and  fifth  days  her 
breafts  were  hard  and  knotty,  but  {he  was  relieved 
by  having  them  well  rubbed  with  a  foft  hand,  up- 
on which  a  little  oil  had  been  poured  to  prevent 
their  chafing, 
i 

Excepting  a  little  cold  water  or  rue  tea  the  child 
tafted  nothing  befides  its  mother's  milk.  It  flept 
eight,  nine,  or  ten  hours  every  night  in  a  crib  bed 
in  another  apartment,  without  any  kind  of  food 
whatever,  had  the  breaft  only  four  times  a  day, 
and  never  feemed  griped  or  uneafy  except  upon 
the  fecond  day  and  night,whilft  the  firft  milk  was 
purging  off  the  meconium.  It  was  in  every  re- 
fpeft  as  well  as  an  infant  could  be,  neither  fretful 


CASES. 

nor  uneafy  as  thofe  children  are  apt  to  be  whofe 
itomachs  are  overloaded  by  largp  quantities  of  im- 
proper diet. 

In  the  courfe  of  the  firft  week  my  patient  eat 
eighteen  Orleans  plumbs,  fifteen  green  gages,  ten 
apricots,  four  pears,  one  apple,  four  large  bunches 
of  grapes,  and  the  greateft  part  of  a  large  melon. 
Except  the  firft  day  me  drank  every  day  two  pints 
of  imperial,  but  never  tafted  cordials,  wine,  ale,  or 
any  kind  of  fpiritous  liquors.  Broths  were  never 
given  to  her,  nor  did  me,  the  third  day  only  ex- 
cepted,  tafte  any  animal  food.  I  knew  her  confli- 
tution  well,  and  was  certain  that  fruit  and  acids 
would  agree  with  it ;  I  was  therefore  fo  far  from 
refuiing  her  the  free  ufe  of  them,  that  I  encouraged 
her  in  it.  Inclination  prompted  her  to  this  kind 
of  diet,  and  experience  had  convinced  her  of  its  u-< 
tility  ;  but  I  muft  own  I  was  greatly  furprifed  that 
me  could  bear  fo  much  cold  air,  a  thing  fo  very 
unufual  to  her,  and  that  too  without  taking  cold. 
This  circumftance  I  fcarcely  could  have  credited 
had  I  not  been  an  eye  witnefs  to  it.  The  cool  air 
was  let  in  cautioufly,  by  degrees  as  (he  was  found 
to  want  and  as  me  perceived  herfelf  capable  of 
bearing  it  ;  but  me  was  fo  fenfible  of  the  relief 
it  afforded,  that  me  frequently  called  out  for  it 
herfelf.  It  is  very  evident  tfcat  had  not  this  meth- 
od been  purfued,  a  bad  fever,  the  fymptoms  of 
N  4  which 


$00  CASES. 

which  appeared  before  her  delivery,  would  have 
been  the  confequence  ;  and  I  have  no  doubt  but 
that  the  fruit  and  the  imperial  corrected  the  bile 
and  prevented  a  loofenefs. 

• 

The  room  fhe  lay  in  was  upon  the  firft  chamber 
floor.  It  was  eighteen  feet  fquare,  and  twelve  feet 
high,  and  had  three  doors  and  three  windows  into 
it.  One  of  the  windows  faced  the  north,  the  oth- 
er two  the  eafl,  but  thefe  lail  were  fo  far  fhaded  by 
another  part  of  the  houfe,  that  the  fun  did  not 
mine  upon  them  after  nine  o'clock  in  die  morning, 
and  indeed  there  was  fo  little  fun  during  the  morn- 
ings of  this  week  that  I  could  not  difcover  the 
room  to  be  at  any  time  affe&ed  with  it.  For  the 
feafon  of  the  year,  the  heat  of  the  air  was  very 
moderate.  The  quickfilver  in  .  Farenheit's  ther- 
mometer generally  flood  at  about  fixty  degrees, 
and  riever  rofe  higher  than  fixty  fix. 

\         .;],-        \ 

During  the  fecond  week  fhe  continued  to  recov- 
er, and  by  degrees  returned  tQ  her  ufual  way  of 
living,  eating  animal  food  once  every  day  and  con- 
tinuing her  fruit  and  vegetable  diet.  The  third 
week  fhe  fat  in  her  drefiing  room  every  day,  and 
her  heats  had  fo  entirely  left  her,  that  a  fire  was 
very  acceptable  to  her. 

As  this  cafe,  in  which  the  method  of  treatment 
I  would  recommend  was  followed  to  its  utmoft  ex- 
tremity, 


CASES.  20* 

tremity,  may  appear  fo  very  extraordinary  to  fome 
perfons  that  they  may  imagine  I  have  been  impofed 
upon  in  feveral  particulars,  I  think  it  proper  to  ob- 
viate any  fuch  objection,  by  declaring,  that  by 
conflantly  redding  in  the  fame  houfe  during  the 
whole  time,  I  was  an  eye  witnefs  of  every  cireum^ 
fiance  I  have  here  related. 

CASE         VIL 

MARY  L  O  R  D  of  Manchefter,  a 
poor  woman,  aged  31,  was  delivered  on  the  25th  of 
May,  1772,  in  the  morning,  by  a  midwife  in  the 
neighbourhood.  She  had  an  eafy  labour,  and  the 
fecundines  came  away  without  difficulty  ;  this  was 
her  third  lying  in.  She  had  a  fhivering  fit  that 
evening,  and  another  the  next  day,  and  on  the 
third  day  fhe  was  feized  with  a  fevere  vomiting 
and  looienefs,  together  with  pains  in  her  head, 
loins,  hips,  and  lower  part  of  her  belly,  which  was 
a  little  fwelled,  and  fo  exceedingly  tender  that  fhe 
could  not  bear  it  to  be  touched.  Thefe  fymptoms 
continued,  and  fhe  gradually  grew  worfe  till  I  firft 
faw  her,  which  was  on  the  fourth  day  in  the  even- 
ing. I  found  her  hot  and  thirfty,  with  a  white 
tOHgue  and  a  quick  pulfe  ;  her  milk  was  much  di- 
minifhed,  and  the  lochia  flopped.  The  whole 
family  lived  in  the  fame  room  in  which  fhe  lay, 
being  the  only  one  they  had  ;  it  was  very  warm. 

having 


A    S 


E   s; 


having  a  large  fire  in  it,  and  fmelt  very  difagreea- 
bly.  I  defired  the  fire  might  be  lefiened,  and  more 
air  let  into  the  room,  accordingly  the  window  was 
fet  open  and  remained  open  all  night.  She  had 
fcarcely  fitten  up  in  bed  fince  her  delivery,  but 
had  lain  in  an  horizontal  pofition  all  the  time.  I 
advifed  her  to  fit  up  frequently  in  bed,  and  to  get 
out  of  it  once  every  day,  to  put  on  clean  linen,  and 
never  to  fuckle  her  child  or  take  any  food  in  an 
horizontal  poilure  ;  to  abftainfrom  ft rong  liquors, 
broths,  and  all  kinds  of  animal  food,  and  to  drink 
buttermilk  or  buttermilk  whey  ;  and  I  directed 
her  to  take  half  a  grain  of  emetic  tartar  with  five 
grains  of  calx  of  antimony  every  four  hours.  On 
the  fifth  day  the  room  was  much  cooler,  and  did 
not  fmell  fo  difagreeably.  She  had  complied  ftri61> 
ly  with  my  directions,  and  was  much  better  in  eve* 
ry  refpea.  On  the  fixth  day  all  her  complaints 
were  vanifhed. 


CASE        VIII. 

ON  the  gd  of  April,  1772,  I  was  fene 

for  to  Mrs. of  W —  H — ,   a  few  miles  from 

hence.  She  had  been  delivered  of  a  fine  child,  as 
Jhefat  upon  the  knee  of  an  ajjiflant,  by  a  young  Sur- 
geon about  five  hours  before  I  faw  her,  and  this 
was  her  fecond  lying  in. 

The 


CASES,     . 

The  placenta  ftill  remained  behind.  She  flood- 
ed much,  and  had  feveral  fainting  fits,  which  came 
on  in  fuch  very  quick  fucceffion  as  to  threaten  im- 
mediate danger.  I  was  defirous  of  getting  the  pla- 
centa away,  as  the  mofl  effectual  method  of  put- 
ting a  flop  to  the  flooding.  To  effecl;  this  I  pull- 
ed gently  at  the  navel  firing,  defiring  the  other 
gentleman  to  make  at  the  fame  time  a  compreffion 
upon  her  belly,  and  directing  her  to  aflift  herfelf 
by  forcing  and  encouraging  what  little  pains  me 
had.  Thefe  means  were  ineffectual,  as  fhe  had 
loft  much  blood.  As  flie  flill  continued  bleeding, 
and  was  reduced  very  low,  I  did  not  think  it  pna- 
dent  to  wait  any  longer  ;  I  therefore  introduced 
my  hand  into  the  uterus,  and  eafily  brought  away 
the  fecundines.  The  flooding  immediately  ceafed, 
and  I  left  her  to  the  care  of  the  gentleman  who 
had  delivered  her,  but  who  likewife  lived  at  fome 
di  fiance. 

•;.    • 

I  heard  no  more  of  her  till  the  afternoon  of  the 
ninth  day,  when  her  friends  fent  for  me  to  come 
over  with  all  expedition,  as  they  then  thought  fhe 
was  dying.  They  informed  me  that  upon  the 
third  day  after  her  delivery  fhe  had  had  a  cold 
ftiivering  fit,  followed  by  a  hot  one  terminating  in 
a  fweat,  that  fhe  had  likewife  a  fecond  upon  the 
fixth  day,  and  that  fhe  laboured  under  a  naufea, 
Attended  with  vomiting,  thirft,  and  total  lofs  of 

appetite. 


204  CASES. 

appetite.  Her  pulfe  was  quick,  and  fmall,  her 
tongue  was  very  white  upon  its  fides,  and  had  a 
brown  dry  flreak  of  abouf  the  breadth  of  half  an 
inch  down  its  middle.  She  gave  fuck  to  her  child, 
had  very  little  milk,  and  complained  of  great  pain 
in  her  belly,  which  was  fo  extremely  tender  that 
fhe  could  not  bear  me  to  touch  it.  Her  lochia 
fuffiou  nt  in  quantity,  but  very  putrid.  She 
not  had  a  ftool  fince  her  delivery,  though  a 
•:  or  iiad  been  given  her  upon  the  fif^h  day  ;  nor 
haa  hie  ever  got  out  of  bed  during  the  firft  week. 
To  thefe  circumftances  I  muft  add,  that  fince  that 
time  fhe  had  drank  no  lefs  than  fevcn  bottles  of 
made  wine,  each  bottle  containing  about  a  quart,  in 
gruel,  whey,  &c.  The  houfe  me  was  in  was  an  olcl 
country  hall,  was  fhuated  in  a  low  marlhy  ground, 
and  was  moated  about  with  a  large  piece  of  water,. 

I  directed  emollient  clyfters  to  be  inje&ed  every 
half  hour,  half  an  ounce  of  Glauber's  falts  to  be 
taken  immediately,  and  the  dofe  to  be  repeated  a 
few  hours  after,  fait  of  wormwood  and  juice  of 
lemons  to  be  taken  in  the  aft  of  effervefcence  every 
two  hours  ;  and  as  I  apprehended  I  had  very  little 
time  to  Me,  I  ordered  her  a  pill  containing  three 
grains  of  calomel  to  be  taken  early  in  the  morning, 
if  flie  had  not  a  plentiful  evacuation  by  ftool  be- 
fore that  time.  In  the  night  Ihe  had  feveral  ftools, 
and  as  I  found  her  much  better  in  th~  morning,  the 

calomel 


CASES.  205 

calomel  was  omitted.  I  now  dire&ed  her  to  take 
half  a  grain  of  emetic  tartar  twice  a  day,  to  con- 
tinue the  fait  of  wormwood  and  juice  of  lemons  as 
before,  to  repeat  the  Glauber's  falts  occafionally, 
to  fit  up  often  in  bed,  and  once  a  day  to  get  out 
of  it. 

By  thefe  means  the  inteftinal  canal  was  kept 
fufficiently  open,  her  fever  difappeared,  and  the 
pains  in  her  belly  foon  left  her.  She  however  con- 
tinued very  weak,  and  her  legs  and  thighs  fwejled 
much,  owing,  no  doubt,  to  the  great  lofs  of  blood 
fuftained  before  the  placenta  could  be  got  away  ; 
to  remedy  which  I  prefcribed  the  bark  and  rhu- 
barb,  with  eight  or  ten  drops  of  the  elixir  of  vitri- 
ol to  be  taken  twice  a  day  ;  but  her  ftomach  could 
not  bear  that,  or  fcarce  any  other  medicine  except 
the  tincture  of  columbo,  which  agreed  with  her 
perfectly  well  :  by  this  medicine,  together  with  a 
folid  diet,  and  gentle  exercife,  me  gradual  recovered 
flrength. 

CASE        IX. 

MA  RYWRIGLEYof  Colly  hurft, 
near  Manchefter,  aged  28,  was  delivered  by  a  coun- 
try midwife,  upon  the  2Oth  of  May,    1772,  as  Jht 
fat  upon  the  knee  of  an  affiflant.     This  was  the  fourth 
lying  in?     Her  delivery  was  natural,  and  the  pla- 
centa 


&o6  CASES. 

cents,  came  away  without  difficulty.  On  the  third 
day  (he  was  feized  with  a  rigour,  grew  afterwards 
hot,  and  then  fell  into  a  cold  clammy  fweat,  which 
was  of  a  long  duration  ;  fhe  had  violent  pains  in 
her  head,  back,  loins,  hips,  and  the  lower  part  of 
the  abdomen,  which  was  fo  exceedingly  tender  that 
Ihe  could  not  bear  to  have  it  touched.  She  had 
frequent  vomitings,  the  pain  and  forenefs  in  her 
belly  made  her  breathing  quick  and  fhort,  and  fhe 
Bad  a  cough  which  added  to  the  pain  and  forenefs. 
In  her  ftools  fhe  had  been  tolerably  regular.  She 
Iiad  been  three  or  four  times  taken  up  whilft  her 
bed  was  made,  but  could  not  bear  to  continue  out 
of  it.  This  was  the  account  her  friends  gave  me 
when  I  was  fir  ft  called  in,  which  was  upon  the 
ninth  day,  early  in  the  morning.  I  found  her  in  a 
copious  fweat,  which  had  continued  a  day  or  two, 
but  all  her  fymptoms  were  evidently  growing 
worfe.  Her  face  was  flufhed,  her  pulfe  was  quick, 
lier  tongue  had  a  white  dry  fur  upon  it,  and  the 
middle  of  it  was  red  and  dry.  She  was  much 
troubled  with  thirft.  Her  urine  was  high  colour- 
•  ed.  Her  lochia,  which  for  fome  time  were  few 
and  very  offenfive.  had  entirely  ceafed.  She  gave 
fuck  to  her  child,  but  her  milk  was  almoft  gone. 
She  lay  with  her  head  and  moulders  lower  than  the 
reft  of  her  body,  and  fhe  informed  me  that  fhe  had 
never  fat  up  in  bed  fmce  her  delivery,  but  had 
taken  all  her  food  in  that  difagreeable  pofture. 

This 


CASE    S.  207 

This  I  apprehended  to  be  one  caufe  of  her  difor- 
der.  She  had  conftant  fire  in  the  room,  and  the 
door  had  never  been  fet  open  to  give  frefh  air  ad- 
mittance. I  opened  the  door,  advifed  her  to  cool 
herfelf  gradually,  to  let  the  fweat  abate  by  degrees, 
and  as  foon  as  it  was  abated,  to  fit  up  in  bed.  I 
alfo  directed  her  to  fit  up  whenever  me  either  took 
nourimment  or  fuckled  her  child,  and  when  (he 
lay  down  ordered  her  head  and  moulders  to  be 
raifed  by  bolflers. 

I  prefcribed  for  her  a  fcruple  of  the  calx  of  an- 
timony, and  two  grains  of  emetic  tartar,  to  be  di- 
vided into  four  papers,  one  of  which  I  directed  to 
be  taken  every  three  hours.  She  was  ordered  to 
ufe  water  poflet,  by  fome  nurfes  called  two  milk 
whey,  for  her  conftant  drink,  to  abftain  from 
ftrong  liquor,  broths,  and  animal  food,  and  I  di- 
rected an  emollient  clyfter  to  be  injected.  I  faw 
her  again  in  the  evening.  I  found  her  much  cool- 
er, but  (he  ftill  complained  of  pain  and  forenefs  in 
the  lower  part  of  the  belly  :  Her  complaints  in 
general  continued,  but  upon  the  whole  fhe  thought 
herfelf  fomething  better.  She  had  taken  the  four 
dofes  of  antimonial  powder,  and  they  had  brought 
up  a  great  deal  of  bile  ;  the  clyfter  too  had  been 
given  her,  but  as  it  had  not  procured  a  (tool,  I  or- 
dered a  fecond  to  be  adminiftered.  I  now  pre- 
fcribed a  fcruple  of  fait  of  wormwood  to  be  taken 

in 


CASES. 

in  a  large  fpoonfu!  of  lemon  juice  during  the  afit 
of  effervefcence.  This  I  ordered  to  be  mixed  un- 
der her  mouth,  that  me  might  breathe  the  fixed 
air  arifing  from  it,  and  this  mixture  I  directed  to 
be  repeated  every  three  hours.  In  an  adjoining 
room  I  fet  a  window  open.  When  I  vifited  her 
next  morning  I  found  her  much  better.  In  the 
night  me  had  two  large  ftools,  exclufive  of  what 
had  come  away  with  the  clyfter.  The  pain,  fwell- 
ing,  and  forenefs  of  her  belly  were  almoft  gone, 
and  me  faid  me  was  in  a  manner  well.  The  door 
of  her  bed  chamber,  and  the  window  of  an  adjoining  , 
room  had  been  kept  open  all  night,  and  there  had  been 
no  fire  in  the  chamber.  She  fat  up  frequently  in 
bed.  and  in  the  evening  got  out  of  it,  and  was  able 
to  walk  with  a  little  afliflance. 

On  the  i  ith  day  fhe  was  confiderably  better  ; 
the  lochia  returned  without  any  offenfive  fmell ; 
the  milk  increafed  in  quantity,  and  her  urine  was 
of  a  more  natural  colour.  The  door  of  her  cham- 
ber and  the  window  in  the  next  room  were  kept 
ot>en  night  and  day,  and  the  fame  medicines  and 
regimen  were  continued.  Her  fever  and  the  pains 
in  her  belly,  £c.  had  left  her,  and  fhe  feemed  quite 
vrcl],  except  that  her  tongue  remained  white  and 
furred,  &nt  me  was  not  the  lead  thirfty.  She  con- 
el  to  recover,  and  when  I  faw  her  upon  the 

fifteenth 


CASES. 

fifteenth  day  her  tongue  was  of  a  natural  colour, 
and  me  had  no  compjaints  except  ,a  little  pain  and 
weaknefs  in  her  groins  when  Ihe  walked,  which  the 
was  not  able  to  do  without  afliftance. 

Upon  the  1 8th  day  fhe  had  a  return  of  her  com- 
ints,  which  gradually  grew  worfe,  but  her  friends 
[id  not  fend  to  acquaint  me  immediately,  and  when 
they  did  I   was  abroad,    therefore  did  not  fee  her 
again  till  the  morning  of  the  twenty  fecond.     She 
had  lain  in  bed  for  the  greateft  part  of  feveral  days5, 
and  was  very  coflive.      She  complained  of  great 
pain  in  her  loins,  hips,  and  lower  part  of  her  belly, 
particularly  about  thejimfhyfisof  the  ospubis,  which 
was  fo  extremely  tender  that  fhe  could  not  bear  to 
have  it  touched.     She  had  frequent   motions   to 
make  water,  attended  with  confiderable  pain,  and 
could    not    make   a    fpoonful  at   a    time,     which 
was   very  high  coloured  :    her  pulfe   beat   120 
ftrokes  in  a  minute.     Tongue  dry  and  parched  ; 
breathing  quick,  fhort,  and  difficult,  which  fhe  faid 
was  occafioned  by  the  pain  in  her  belly.     Her  lo- 
chia  flopped  ;  her  milk  diminifhed.     She  fweatecf 
prpfufely,  and  her  face  was  flufhed.     I  ordered  the 
^hUmonial  powders  to  be  repeated  every  four  hours, 
an  emollient  clyfler  to  be  injected,  and  directed  the 
nurfe  to  raife  her  up  frequently  in  bed,  and  to  keep 
'Open  the  doors  and  windows.     The  powders  puked 
her  a  little,  but  fhe  had  no  ftool.    In  the  evening 
O  I* 


aio  CASES, 

I  ordered  her  another  clyfter,  and  the  fait  of  worm- 
Wood  and  juice  of  lemons  to  be  taken  every  three 
hours  during  the  aft  of  effervefcence,  and  me  re- 
turned to  the  fame  kind  of  diet  and  regimen 
which  had  been  at  firft  prefcribed. 

She  had  a  loofe  black  fetid  ftool  in  the  night ; 
and  on  the  2gd  day  in  the  morning,  me  made  wa- 
ter rather  more  eafily,  and  there  was  a  fmall  ap- 
pearance of  the  lochia,  but  in  other  refpefts  flie 
was  much  the  fame.  In  the  afternoon  ftie  was  ve- 
ry hot,  and  fo  delirious  that  they  could  fcarcely 
hold  her  in  bed.  This  I  mufl  obferve  was  a  very- 
hot  day,  and  the  room  me  lay  in  faced  the  fouth, 
which  certainly  contributed  to  increafe  her  com- 
plaints. In  the  evening  me  grew  cooler  and  more 
calm,  and  in  the  night  made  with  eafe  a  tolerable 
quantity  of  clay  coloured  urine,  which  depofited  a 
copious  fediment.  Windows  and  doors  kept  open. 
-  i* 

24th.  In  the  morning  me  had  a  fmall  quick 
pulfe,  which  beat  116  ftrokes  in  a  minute,  but  in- 
termitted after  every  5th  or  6th  ftroke,  her  pains 
were  fomething  eafier.  This  was  likewife  a  very 
hot  day,  I  therefore  advifed  her  friends  to  move 
her  into  another  room,  but  me  was  fo  ill  they 
thought  fhe  could  not  bear  it,  and  it  was  omitted. 
In  the  afternoon  her  delirium  returned,  but  not- 
with  fo  much  violence.  The  effervefcing  mixture ; 

was 


t    A    S    E    S.  211 

was  given  every   two  hours.     In-  the  evening  ftie 

had  a  large  black  fetid  ftool. 

' 

25th.  In  the  morning  her  pulfe  was  flower  and 
ftronger,  and  more  regular,  beating  96  ftrokes  in  a 
minute,  but  fhe  complained  of  very  great  pain  iri 
the  hypogaftric  region.  I  directed  her  to  take  half 
an  ounce  of  Glauber's  fait  immediately,  and  the 
fame  quantity  in  an  hour  or  too  after,  and  to  have 
the  clyfler  repeated,  but  they  did  not  procure  a 
ftool.  Early  in  the  afternoon,  when  the  room 
was  the  hotted,  her  delirium  returned,  but  went  ofF 
again  as  the  heat  of  the  day  abated,  but  her  pain 
continued  with  fuch  violence  as  to  make  her  quite 
impatient.  I  ordered  another  clyfler  to  be  injecl> 
ed,  and  a  pill  to  be  given  immediately,  containing 
three  grains  of  calomel  and  half  a  grain  of  emetic 
tartar.  Thefe  procured  her  feveral  very  loofe  of- 
fenfive  ftools  in  the  night,  and  with  them,  great  eafe* 

26th.  I  found  her  much  better,  the  pain,  fore- 
nefs,  and  fever,  having  almoft  left  her  ;  pulfe 
calm  and  regular,  beating  only  88  ftrokes  in  a 
minutCi  Effervefcing  mixture  continued.  This 
day  was-  rather  cooler  than  the  three  preceding 
ones  ;  fhe  had  no  delirium  ;  but  her  pulfe  was 
quicker  in  the  afternoon;  beating  i  do  in  a  minute. 


Had  not  flept  much  in  the  night,  but 
was  cool  in  the  morning  ;  pulfe  §8,  did  not  com- 
O  2  plain 


212  CASE     S. 

plain  of  pain  except  when  {he  moved,  but  the  fore- 
nefs  at  the  lower  part  of  the  belly  ftill  continued. 
I  preicribed  her  the  bark  with  a  little  rhubarb  to 
keep  her  gently  open.  She  was  removed  into  an- 
other room  which  faced  the  north,  and  in  the  af- 
ternoon her  pulfe  was  reduced  to  82  ftrokes  in  a 
minute. 

The  bark  and  rhubarb  procured  her  feveral 
ftools  in  the  evening,  which  were  of  a  more  natu- 
ral colour,  and  not  fo  offenfive.  She  had  a  good 
night. 

2 8th.  In  the  afternoon  her  heats  returned  a 
little,  and  her  chief  complaint  was  pain  in  making 
water.  Bark  and  rhubarb,  and  the  effervefcing 
mixture  were  ftill  continued,  and  I  defired  her  to 
take  a  teafpoonful  of  the  fwcet  fpirit  of  nitre,  and 
to  drink  plentifully  of  milk  and  fmall  liquors. 

;  •'. ',  t 

r>  6th.  After  a  very  good  night,  had  no  com- 
plaints remaining. 


CASE     X, 

MARY  BURGESS  of  Carrington  in. 
Cheftiire,  aged  38,  was  delivered  September  2Oth, 
1770,  of  her  firtl  child,  by  the  affiftance  of  the 

crotchet^ 


C    A    S    E    S. 

crotchet,  having  a  very  laborious  birth.  No  at- 
tempts were  made  to  extraft  the  fecundines  that 
night.  The  next  day  the  gentleman  who  delivered 
her  deiired  I  would  vifit  her  along  with  him.  I 
found  her  very  hot,  and  her  rkilfe  quick  and  ftrong; 
ihe  had  frequent  returns  of  pains,  which  feemed 
to  be  efforts  to  expel  the  fecundines,  and  during 
every  pain  a  difcharge  of  blood.  I  took  hold  of 
the  navel  firing,  pulled  gently  at  it,  defiring  her  afc 
the  fame  time  to  encourage  her  pains,  and  in  about 
a  quarter  of  an  hour  the  fecundines  CaTne  away. 
Though  only  about  twenty  three  hours  had  elapfed 
betwixt  the  delivery  of  the  child  and  the  fecundines, 
yet  they  were  in  a  very  putrid  flate,  as  was  evident 
both  by  the  fmell  and  their  being  remarkably  difcol- 
oured.  I  took  my  leave  of  her,  defiring  her  to  keep 
cool,  have  frefh  air  frequently  admitted  into  the 
room,  and  to  fit  up  often  in  bed  ;  and  I  had  the 
fatisfa&ion  afterwards  to  hear  that  me  recovered 
without  any  farther  difagrceable  fymptams.  • 

. 

e  A-S  E    -XL 

•    i 

Extracl  of  a  Letter  from  Mr. to  Mr.  White, 

ri*    ~  :vb    -  '    \O  01; 

SIR, 

MARY  DAVENPORT  of  Bariow- 

Moor,  in  the  County  of  Lancafter,  a  ftrong  health* 
O  3  i  ui 


CASES. 

ful  country  woman,  about  36  years  of  age,  was  de<* 
vlivered  January  27,  1771,  of  her  fixth  child,  asjhe 
Jat  upon  a  woman's  knee,  and  had  an  eafy  natural  la* 
bour.  I  ufed  all  the  gentle  methods  I  was  acquainted 
with  to  bring  the  placenta  away,  but  in  vain.  Af- 
ter waiting  fome  time  without  effect,  her  friends 
growing  uneafy,  I  defired  you  might  be  fent  for, 
which  was  done,  but  you  was  otherwife  engaged, 
and  could  not  attend.  The  next  day  I  made  fome 
further  attempts  to  extract  the  placenta  by  gently 
pulling  at  the  funis,  but  with  no  better  fuccefs. 

On  the  third  day  I  laid  hold  of  the  navel  firing, 
with  an  intention  of  making  another  attempt  to 
bring  away  the  fecundines,  when  the  navel  firing 
feparated  from  the  placenta  without  any  force  be- 
ing ufed,  and  was  in  a  very  putrid  ftate.  This 
day  her  milk  began  to  come,  but  difappeared  a- 
gain  in  the  evening.  The  difcharge  of  the  lochia 

was  in  proper  quantities,  but  exceedingly  ofFenfive. 
i 

I  do  not  recollect  that  fhe  had  any  cold  fit,  but 
(he  had  frequent  hot  burping  fits  fucceeded  by 

fweats, 

' 

On  the  fifth  day  (he  had  a  clyfter  given  her, 
which  procured  a  ftool,  and  foon  after  the  fecun- 
came  away  in  a  very  putrid  ftate, 

On 


CASES.  215 

.  On  the  6th  day  fhe  complained  of  great  oppref- 
iion  about  the  precordia,  had  a  quick  pulfe,  a  white 
dry  tongue,  and  her  breath  was  the  moft  remark- 
ably offenfive  I  ever  obferved.  I  afked  her  friends 
whether  it  had  been  ufually  fo,  but  they  allured 
me,  that  before  her  delivery,  fhe  had  as  fweet  a 
breath  as  any  woman  in  England.  On  the  i2tha 
large  quantity  of  white  miliary  puflules  appeared, 
particularly  about  the  bread. 

On  the  14th  a  hiccoughing  came  on  ;  the  miliary 
eruption  continued  out  till  the  day  of  her  death* 
which  happened  on  the  2 ad  from  her  delivery. 

CASE         XII. 

JVlR. ,  a  gentleman  of  abilities 

in   his   profeffion,   has   informed   me,    that   in  the 

month  of  March,  1772,  he  delivered  Mrs.  — , 

as  /he  fat  upon  the  knee  of  an  a/iftant.  The  pofition 
of  the  infant  was  natural,  the  placenta  remained  be- 
hind, and  the  mouth  of  the  womb  contracting  it- 
felf,  rendered  it  unfafe,  at  leaftat  that  time,  to  ex- 
tracl;  it.  Another  very  able  accoucheur  was  confulted, 
and  they  both  agreeing  that  it  was  prudent  to  leave 
nature  to  herfelf,  no  attempts  were  made, 

On  the  fourth  day  the  fecundines  were  excluded 
without  affiftance,  and  foon  after  fhe  began  to  flood 
P  4  exceflivetyv 


CASES, 

exceffively.  The  flooding  could  not  be  fuppreffed, 
and  fhe  died  the  fame  day. 


CASE        XIIL 

i 

JVlR.  ,  an  ingenious  furgeon, 

told  me  he  delivered  a  ftrong,  healthy,  country 
woman,  of  a  fine  child,  asjhefat  upon  the  knee  of  an 
ajjijlanti  He  made  no  attempt  to  bring  away  the 
placenta,  having  been  inftru&ed  by  a  teacher  of 
midwifery,  whofe  le&ures  he  had  attended,  that 
leaving  it  behind  was  never  productive  of  difagree- 
able  confequences.  After  waiting  a  confiderable 
time  in  vain  for  its  exclufion,  no  bad  fymptoms 
appearing,  he  left  her  as  he  thought,  in  perfect 
fafety  ;  but  in  the  middle  of  the  night  fhe  began 
to  flood  Extremely,  and  lie  was  again  fent  for, 
Jle  made  what  hafle  he  could,  but  living  feveral 
miles  from  his  patient,  he  came  too  late.  She  was 
dead,  and  the  placenta  unexcluded. 
--:•-  T 

C     A     S  .  E        XIV. 

1  H  E  fame  gentleman  has  alfo  in- 
formed me,  that  in  the  beginning  of  March,  1772, 
he  was  fent  for  to  a  woman  who  had  five  days  be- 
fore been  delivered  of  a  child  fry  a  country  mid- 
wife, 


CASES. 

wife,  asjhefat  upon  the  knee  of  an  ajjijlant  :  fhe  had 
flooded  extremely,  he  found  her  dying,  and  the 
fecundines  unexcluded. 


CASE         XV. 

rj. 

1  HAVE  been  told  by  a  Surgeon  in 
Chefhire,  that  having  delivered  a  healthful  woman, 
who  had  a  very  eafy  labour,  he  made  no  attempts 
to  bring  away  the  placenta,  but  left  her,  in  full  ex- 
pectation of  its  being  expelled  without  danger.  On 
the  third  day  he  was  again  fent  for  upon  account 
of  a  violent  flooding.  He  lived  only  three  or  four 
miles  from  the  patient,,  went  as  foon  as  poflible, 
but  found  her  dead  without  the  exclufion  of  the 
placenta. 


- 


CONCLUSION. 


2l8 


CONCLUSION. 


.BEFORE  I  draw  any  inferences  from 
the  cafes  I  have  related  concerning  the  management 
of  the  placenta,  in  order  to  ft  ate  the  matter  fairly, 
it  will  be  neceffary  to  inform  my  readers  that  I 
have  likewife  known  many  misfortunes  arife  from 
the  manual  extraction,  when  it  has  been  improper- 
ly or  untimely  performed;  fuch  as  inverfions  of 
the  uterus,  and  death  in  confequence  of  it,  lacera- 
tions of  the  «neck  of  the  womb,  and  inflammations 
of  that  organ,  which  have  frequently  ended  in  fter- 
ility  or  death.  The  advocates  for  leaving  the  pla- 
centa entirely  to  nature,  certainly  a6l  upon  the  moft 
laudable  plan,  and  no  pe^fon  has  a  higher  opinion 
of  the  powers  of  nature  than  myfelf  ;  but  they 
have  ended  where  they  mould  have  begun.  They 
fet  out  with  art,  and  end  ,with  nature.  It  would 
have  been  better  if  they  had  reverfed  their  practice, 

We 


CONCLUSION. 

We  do  nature  great  injuftice,  if  by  taking  the 
reins  into  our  own  hands,  we  fir  ft  interrupt  her,, 
put  her  out  of  her  courfe,  and  then  leave  her  to 

berfelf. 

~~- 

' 

Woman  in  a  Mate  of  nature  was  never  deliver- 
ed in  a  hot  room,  nor  with  many  clothes  upon  her  : 
By  heat,  and  a  multitude  of  clothes,  the  mufcles 
lofe  their  contra6lile  power. 

Woman  in  a  flate  of  nature  would  not  think  of 
being  delivered  in  an  upright  pofture,  or  upon  the 
knee  of  an  affiftant. 

Woman  in  a  ftate  of  nature  would  not  have  the 
child  dragged  from  her ;  it  would  be  gradually  ex- 
pelled by  the  contractile  power  of  the  uterus  ;  the 
fame  progreflive  contractive  power  would  expel 
the  fecundines  ;  and, 

Woman  in  a  ftate  of  nature  would  not  after  de- 
livery lie  in  an  horizontal  pofture,  in  a  warm  bed, 
drinking  warm  liquids  for  a  week,  or  even  a  day. 

We  fhould  be  confiftent  in  our  pra&ice ;  we 
fliould  imitate  nature  through  her  whole  progrefs, 
and  not  in  the  latter  part  only  ;  but  we  muft  alfo 
make  proper  allowances  for  thefc  times  and  this 

country, 


CONCLUSION 

country,  where  women  are  fo  far  removed  from  a 
liate  of  nature. 

We  may  however,  in  my  opinion,  draw  the  fol- 
lowing conclulions  : 

- 

ift.  Putrid  fevers,  floodings,  and  death,  have 
been  occafioned  by  retentions  of  the  fecundines. 

sdly.  Floodings  occafioned  by  a  retention  of 
the  placenta  generally  ceafe  by  a  timely  removal 
of  it. 


gdly.  The  manual  extra&ion  of  the  placenta 
mould  never  be  attempted  whilft  there  are  any 
fpafmodic  contractions  either  in  the  neck  or  acrofs 
the  middle  of  the  womb. 

4thly.  Opiates  will  generally  remove  thefe  con- 
tractions. 

rr"'^ 

5thly.  Though  many  cafes  have  happened  when 
the  placenta  lias  remained  fome  days  in  the  uterus 
after  the  delivery  of  the  child,  without  manifeft  in- 
jury, yet  it  is  not  generally  fafe  for  a  woman  to  be 
left  by  the  accoucheur  before  it  is  removed. 

Laflly.  When  every,  part  of  the  child  is  expell- 
ed folely  py  the  contraftile  power  of  the  uterus,  in 

fuch 


CONCLUSION. 


221 


fuch  a  manner  that  the  flioulders  are  permitted  to 
make  their  proper  turns,  the  woman  having  been 
kept  in  an  horizontal  pofition,  and  the  cool  regi- 
men having  been  ftriclly  obferved,  there  will  fel- 
dom  or  never  be  occafion  for  the  manual  extraction 
of  the  placenta. 


POSTSCRIPT. 


222 


I 

i 

POSTSCRIPT. 


OINCE  the  foregoing  papers  were 
compleated,  I  have  with  great  pleafure  perufed  a 
Treatife  on  the  Puerperal  Fever  by  the  learned 
Dr.  Hulme,  which  contains  many  excellent  prac- 
tical directions  for  the  management  of  lying  in 
women.  He  appears  thoroughly  convinced  that 
Miliary  fevers  are  the  offspring  of  heated  air  and 
warm  regimen,  which  opinion  is  ftrongly  fupported 
by  the  following  fa6l  :  He  fays,*  "  I  have  at- 
"  tended  more  than  fourteen  hundred  women  in 
"  the  London  lying  in  hofpital,  yet  I  do  not  re- 
"  member  ever  meeting  with  an  inftance  of  the 
<(  Miliary  fever  in  that  houfe.  This  I  attribute 
"  partly  to  the  cool  regimen  that  is  ftriclly  enjoin- 
"  ed  to  be  obferved  there,  but  above  all  to  the  ad- 
"  miflion  of  cool  air,  which  is  ordered  to  be  let  in- 

"  to 

*  Page  9& 


POSTSCRIPT.  223 

"  to  the  wards  every  day,  at  an  opening  in  the  wm- 
"  dows.  And  probably  it  is  for  the  fame  reafon, 
"  alfo,  that  I  never  have  obferved  in  that  excellent 
"  afylum  for  pregnancy  any  petechice,  vibices,  exam* 
"  themata,  veficulce,  punfticultz,  or  any  other  febrile 
"  eruptions,  joined  with  the  fever  which  we  are 
{C  now  treating."  But  although  this  method  was 
effectual  in  preventing  Miliary  and  other  eruptive 
fevers,  yet  he  did  not  find  it  fufficient  for  the  pre- 
vention of  the  Puerperal  fever.  In  fa  ft,  a  cool 
regimen,  and  opening  the  windows  in  the  day  time, 
cannot  alone  prevent  this  fever  in  a  ward  which 
contains  feveral  lying  in  women,  where  the  efflu- 
via from  breathing  and  perfpiration,  and  from  the 
lochial  difcharge,  becoming  putrid  by  ftagnation 
whilft  the  patient  is  in  an  horizontal  pofture,  muft, 
by  being  pent  up  during  a  whole  night  without 
ventilation  render  the  air  very  foul  and  ofFenfive. 
The  juices  that  are  extracted  from  meat  by  boiling 
are  the  moft  alkalefcent  parts  of  it,  and  of  courfe 
the  moil  improper  in  putrid  difeafes.  Of  all  ani- 
mal diet,  the  leail  alkalefcent  are  white  meats  of 
young,  tame,  lean  animals,  which  have  fed  upon 
vegetables,  are  frefh  killed  by  bleeding  to  death, 
and  have  been  well  boiled.  The  great  quantities 
of  broth  allowed  in  the  hofpital  diet,  and  that  too 
often  made  with  water  replete  with  particles  of  pu- 
trid animal  or  vegetable  fubftances,  may  contrib- 
ute 


224  POSTSCRIPT. 

ute  toincreafe  a  putrefcent  difpqfition,  and  give 
ev§ry  flight  feverifh  complaint  a  difpofition  to- 
wards putridity. 

But  as  1  have  already  given  at  large  my  ideas 
of  the  caufe  of  this  difeafe,  I  mail  now  confine  my- 
felf  to  a  few  remarks  upon  Dr.  Hulme's  opinion 
concerning  this  matter.  And  I  mufl  firft  premife, 
that  the  Doctor,  fpeakirjg  of  the  caufe  of  this  dif- 
order  arifmg  from  preflTure,  fays,  ."  As  I  am  no 
"  practitioner  jri  midwifery,  I  have  not  ha(J  an  op- 
<£  portunity  of  attending  fo  minutely  to  the  differ- 
<c  ent  complaints  arifing  from  this  fuppofed  pref- 
"  fure  during  the  flate  of  pregnancy,  as  thofe  who 
exercife  that  art."  But  whatever  opportunities 
the  Doctor  may  have  been  wanting  in,  to  difcover 
the  true  caufe  of  this  diforder,  he  feems  to  be  thor- 
oughly acquainted  with  it,  when  it  is  a£lually  exift- 
ing  ;  and  his  directions  for  the  cure  of  it  are  prop- 
er and  judicipus,  and  fuch  as  ought  to  be  read  by 
every  perfon  who  directs  the  management  of  child- 
bed women. 

In  order,  however,  to  form  ajuft  idea  of  the  pu- 
erperal flate  in  general,  it  is  neceffaiy  to  be  ac- 
quainted with  it  in  all  its  varieties,  and  not  only 
when  accompanied  with  dileafe,  but  in  its  more 
common  fituation  of  a  mere  regular  and  eafy  oper- 
ation of  nature. 

The 


POSTSCRIPT. 

The  immediate  caufe  of  the  puerperal  fever,  ac- 
cording to  Dr.  Hulme,  is  an  inflammation  of  the 
interlines  and  omentum  ;  for  the  truth  of  which  af- 
fertion  he  appeals  to  directions.  In  each  of  the 
fix  difleftions  he  has  given,  he  likewife  found  a 
gangrene  of  the  inteftines  or  omentum,  or  both. 
Before  we  draw  any  conclufions  from  thefe  appear- 
ances after  death,  it  will  be  neceffary  to  examine 
whether  fimilar  appearances  have  not  been  found 
after  other  diforders,  and  then  to  inquire  whether 
thofe  diforders  were  properly  of  the  inflammatory 
or  putrid  diathefis.  For  both  thefe  purpofes  I  beg  the 
reader's  attention  to  the  following  quotations  fe'left- 
edfrom  feveral  authors  of  the  higheft  character, 
who  have  given  their  obfervations  without  any  view" 
to  hypothecs,  but  folely  to  advance  real  practical 
knowledge ; 


"  Upon  opening  the  bodies  of  the  dead  I  have 
"  conftantly  found  the  great  guts,  either  entirely 
"  mortified,  or  partly  inflamed,  partly  mortified,  the 
"  retfum  being  generally  moft  affected;  in  many  I 
"  have  ieen  fcirrhous  tubercles  ftraitenmg  thecav- 
"  ity  of  the  colon  in  feveral  places ;  in  a  few  there 
"  were  fmall  abfcefles  in  the  cellular  membrane  o£ 


"  Sometimes   the  fmall  guts  were  perfectly. found 
"  in  appearance ;   but  more  frequently  their  lower 
"fart  was  inflamed,  the  convolutions  being  often p re- 
P  *'  ternaturally 


3*6  P  O  S  T  S  C  R  I  P  T. 

"  ternaturally  connected  to  each  other  by  membranes  as 
"  the  lungs  fometimes  are  to  the   pleura.     In  two 
"  people  the  omentum  was  almoft  entirely  wafted, 
"  the   fmall  remains  of  it  being  quite  black  while 
"  purulent  matter  was  found  in  the  cavity  of  thQabdo- 
"  men  ;  in  feveralit  was  inflamed,  and  adhered  both 
"  to  the  guts  and  peritoneum ;  for  the  moft  part  the 
"  gall  bladder  was  full  of  dark  bile ;  and  the  fpleen, 
"  more  or  lefs,  in  a  putrid  condition." 

C  leghorn  on  the  Epidemic  Dif.  of  Minorca, 
chap.  5.  on  the  Dyfentery,  p.  246. 

"  I  have  examined  the  bodies  of  near  a  hun- 
"  dred  perfons  who  perifhed  in  thefe  fevers,  and 
"  conflantly  found  one  or  other  of  the  adipofe 
"  parts  in  the  lower  belly,  the  cawl,  mefentery.  colon, 
"  Sec.  of  a  dark  black  complexion,  or  totally  cor- 
"  rupted ;  the  vefica  fdlea  full  and  turgid,  and  the 
"  ilomach  and  intellines  overflowing  with  bilious 
".matter."  , 

Ibid.  Chap.  3.  on  Tertian  fevers,  p.  180. 

"  That  as  there  is  the  greateft  tendency  to  pu- 
c*  trefadion  through  the  whole  courfe  of  the  ill- 
"  neft,  it  generally  terminates,  when  it  proves  fa- 
**  tal,  either  in  an  actual  mortification  of  fome  part, 
l<  or  in  an  abfcefs  of  the  brain,  often  ichorous  ; 
**  that  the  intejlines  more  farticularly  are  fubjett  to 

"  mortify, 


POSTSCRIPT.  22y 

u  mortify,  as  few  die  without  cadaverous  and  in- 
"  voluntary  ftools." 

Sir  John  Pringle  on  the  Jail  or 
Hofpital  Fever,  p.  303. 

: 

"  From  the  numerous  diffe&ions  of  thofe  who 
"  died  of  the  plague  at  MarfeilleSj  it  appeared  that 
"  fome  of  the  vifcera  were  always  mortified  and  in** 
"flamed" 

Traite  de  la  pefte,  part  i. 

Dr.  Lind  has  favoured  us  with  an  account  of 
fome  difie&ions  which  he  had  from  Mr.  Bogue,  ah 
ingenious  furgeon  at  Titchfield,  of  perfons  who 
died  of  putrid  intermitting  fevers  ;  in  one  of  them 
the  feat  of  the  diforder  appeared  to  be  in  the  liver, 
where  two  large  abfceifes  were  formed,  but  ther* 
was  rio  mortification  of  any  of  the  parts  except  the 
cmenttim,  which  he  fays  was  partly  mortified.  Thfe 
jlomach  was  found,  but  much  diftended  with  wind, 
and  the  veflels  on  the  inteftines  in  a  ftate  of  pleni- 
tude. The  reft  of  the  vifcera  were  perfectly  found, 
Eflay  on  the  Dif.  of  Europeans,  p.  36. 

Monfieur  le  Cat,  in  his  account  of  thofe  malig- 
nant fevers  that  raged  at  Rouen,  gives  us   the  fol- 
lowing diffeclions  of  thofe  who  died  of  epidemical 
P  a  bloody 


S28  POSTSCRIPT. 

bloody  fluxes,  preceded  by  lownefs   of  fpirits,  at- 
tended with  violent  colics  and  a  lharp  fever  : 

"  One  Le  Fevre  had  blood  difcharged  even  up 
"  to  the  ftomach  ;  and  the  inner  membrane  of  this 
*'  organ,  towards  the  pylorus,  was  in  the  famecon- 
"  dition  with  that  of  the  great  interlines  of  the 
"  foregoing  patient.  The  duodenum,  jejunum, 
"  and  the  beginning  of  the  ileum,  was  found  ;  the 
"  end  of  the  ileum  was  inflamed  ;  and  the  end  of 
"  the  large  inteflines  were  gangrened.  In  one, 
**  called  Saracin,  the  fame  interlines  were  all  nwttifi- 
"  ed-f  the  caecum  and  half  the  colon  were  as  large 
M  as  a  ftomach,  diftended  with  wind.  Their  canals 
"  were  full  of  a  bloody  matter,  and  their  inward 
^  membrane  feparated  very  eafily.  The  gangrene 
"  feemed  particularly  to  affeft  this  coat.  The 
"  ftomach  and  fmall  guts  were  found  ;  neverthe- 
*c  le&,  his  death  was  preceded  by  the  hiccough." 
•  Phil.Tranf.  vol.  49.  part  i.  p.  51, 

•  ;• 

*f  Some  of  the  malignant  fevers  which  we  had  at 
"  the  Hotel  Dieu  in  1750,  were  reported  to  be 
"  caufed  by  infection  conveyed  in  bales  of  horfe 
*c  hair,  to  which  was  left  fome  of  the  animals*  flefh 
<c  that  was  become  putrified  :  And  yet  thefe  fevers 
"  did  not  diffqr  from  others  which  we  have  already 

.V  deferred, 

"  Martha 


POSTSCRIPT. 


"  Martha  Renon,  a  girl  of  about  twenty  years  of 
"  age,  who  died  of  this  fever,  had  the  mefentery 
"  filled  with  obftrucled  glands,  and  the  inteftints 
"  mortified  in  different  places/' 

Ibid.  p.  55. 

Thefe  quotations,  I  apprehend,  will  prove  in  the 
moft  convincing  manner  that  inflammation  and 
mortification  of  the  inteftines  and  omentum  always 
conftantly  attend  fatal  fevers  of  the  putrid  or  ma- 
lignant clafs,  where  there  can  be  no  fufpicion  that 
thefe  parts  were  the  original  feat  of  the  difeafe  ; 
and  that  therefore  fuch  appearances  upon  difle&ion 
are  only  to  be  looked  upon  as  the  confequences  of 
a  particular  fymptom,  and  not  effentially  charac- 
terizing the  diforder.  The  frequency  of  thefe  ap- 
pearances may  probably  be  accounted  for  by  what 
has  been  before  obferved  of  the  liablenefs  of  the 
inteftines  to  receive  a  putrefactive  taint,  from  their 
peculiar  fituation  and  texture,  and  the  nature  of 
their  contents. 

The  chief  predifponent  caufe  of  this  fever  is  by 
Dr.  Hulme  fuppofed  to  be  the  preffure  of  the 
gravid  uterus  againft  the  inteftines  and  omentum. 
He  fays,  "  The  omentum  in  the  latter  part  of  preg- 
"  nancy  muft  either  be  flat,  which  is  its  natural 
"  fituation,  or  be  rumpled  or  carried  up  by  the 
P  3  "  gravid 

. 
. 


POSTSCRIPT. 

"  gravid  uterus  in  folds  or  doublings.     When  this 
"  laft  is  the  cafe,  which   probably  is  not  unfre- 
<c  quently  fo,  the  danger  of  a  ftrangulated  circula- 
"  tipn  will  be  greater."     But  were  any  thing  of 
this  kind  to  happen,  ^  Would  not  the  diforder  rather 
take  place  before  delivery,  and  be  immediately 
removed  at  that  period  ?  This  would  certainly  be 
the  cafe  if  any  real  analogy  fubfifted  between  the 
caufe  of  the  puerperal  fever,  and  the  ftrangulation 
of  the  inteflines   and  omentum  in  a  hernia  ;  fince 
the  moft  alarming  fymptoms  attending  the  latter 
are  immediately  removed,  unlefs  the  inflammation 
is  gone  too  far,  as  foon  as  the  preflure  caufing  the 
ftrangulation  is  taken  off,  whether  this  be  erfe&ed 
by  art  or  nature.    If  this  were  the  true  caufe  of  the 
puerperal  fever,  it  would  chiefly  happen  to  women 
at  their  firft  labour,  when  the  abdominal  mufcles 
are   lefs    yielding,    and    tlre-pnmn  -mure    violent  j 
which  I  do  not  find  either  from  the  inftances  he 
has  given,  or  thofe  I  have  myfelf  obferved,  to  be 
the  cafe  ;  but  rather  the  contrary.    Upon  this  fup- 
pofition  too  it  is  impoflible  to  account  for  the  dif- 
eafe  being  more  common  and  fatal  in  large  towns 
and  in  hofpitals,  than  in  the  country,  and  private 
practice,  whereas  other  inflammatory  diforders  are 
more  frequent  amongft  the  hard  labouring  country 
women,   who  ufe    much   violent   exercife,   than 
amongft  the  fedentary  inhabitants  of  a  large  town. 
?<  As  foon  as  aftual  labour  comes  on/'  the  Doctor 

fays. 


POSTSCRIPT.  331 

fays,  "  the  woman  is  feized  with  particular  pains, 
«'  returning  at  intervals,  which  occafion  fuch  re- 
"  peated  convulfive  motions  upon  the  abdominal 
"  mufcles  and  diaphragm  as  to  force  the  child 
"  down  into  the  pelvis  and  caufe  delivery.  By  this 
"  painful  and  laborious  aclion  the  body  is  much 
"  heated,  a  fever,  for  the  time  being,  is  produced, 
44  the  inteflines  and  omentum  are  flrongly  rubbed, 
"  and  ground  as  it  were  againil  the  gravid  uterus 
"  at  every  convulfive  throe,  till  the  child  makes 
"  its  way  into  the  pelvis."  This  reprefentation  of 
labour  is  not,  I  imagine,  perfectly  accurate.  Thofe 
pains  which  are  called  falfe  or  fpurious  do  indeed 
occafion  convulfive  throes  in  thefe  mufcles  ;  but 
the  chief  agent  in  expelling  the  fetus  is  certainly 
the  contraction  of  the  uterus,  which  is  only  aflift* 
ed  and  determined  to  a  proper  direction  by  the  ac- 
tion of  the  diaphragm  and  abdominal  mufcles.* 
Nor  do  I  apprehend  if  their  action  were  even  a$ 

violent 

*  "  It  is  of  great  importance  to  practitioners  of  midwifery  to  know,  and 
**  conftantly  bear  in  mind,  that  the  action  of  the  diaphragm  and  abdominal 
**  mufcles  is  not  fufficient  to  empty  the  womb,  and  that  the  expulfion  of  its 
**  contents  depends  on  the  contractile  powers  of  the  mufcular  fibres  which 
^  enter  into  its  texture  ;  becaufe  this  knowledge  is  what  muft  regulate  the 
**  mano2uvres  refpefting  the  delivery  both  of  the  child  and  of  the  placenta. 
"  What  are  termed  true  labour  pains  are  the  rcfult  of  repeated  contractions 
"  in  thefe  uterine  fibres,  which  perfons  experienced  in  this  branch  of  prac- 
*«  tice  know  well  how  to  diftinguifh  from  the  falfe  pains,  which  are  noth- 
"  ing  more  than  fpafmodic  afFeftions  of  the  abdominal  mufcles  ;  the  effort* 
•  *  from  thefe  falfe  pains  appear  to  force  down  the  ciiild,  but  are  never 
p  found  fufficient  to  expel  it." 

Maebride's  Introduction  to  the  Practice  of  Phyfick, 


POSTSCRIPT. 

violent  and  forcible  as  the  Do&or  defcribes,  that 
any  inflammation  would  be  raifed  by  the  preflure 
of  fuch  foft  parts  upon  each  other,  where  from  the 
multitude  of  vafcular  anaflomofes  no  degree  of 
obftruftion  in  the  circulation  can  take  place.  The 
pafTage  even  of  a  ftone  through  the  gall  dufts  or 
ureters  rarely  occafions  any  diforder  in  thofe  parts 
which  is  not  inilantly  removed  when  the  effort  is 
over  ;  and  certainly  the  compreflion  which  the 
omentum  or  interlines  may  fuffer  in  a  labour,  can- 
not be  compared  to  that  of  the  lower  part  of  the 
uterus  while  the  head  is  pafling  between  the  proc- 
eifes  of  the  ifchia,  in  which  fituation  it  often  con- 
tinues many  hours  impelled  by  the  ftrongeft  pains, 
without  occafioning  any  fubfequent  inflammation. 
Neither  does  it  appear  that  the  puerperal  fever  is 
more  common  or  fatal  after  the  moft  laborious 
cafes,  nor  where  the  fpurious  abdominal  pains 
have  been  mofl  urgent ;  for  all  the  late  writers 
feern  to  agree  that  it  comes  on  equally  after  the 
eaiiefl  deliveries. 

JrJ  ,,.w  ;,  •)%%. 

The  Doclor  ufes  as  an  argument  in  favour  of 
his  hypothefis  that  it  gives  a  fatisfaclory  anfwer  tP 
this  queftion,  "  ±  Why  all  lying  in  women  have 
"  been,  and  ever  will  be,  fubjeft  to  this  difeafe  ? — 
f '  becaufe  the  caufes  that  produce  it  are  common 
u  to  pregnant  women  at  all  times,  and  in  all  cli- 
"  mates/'  Now  it  appears  to  rae  that  the  very  flron§- 

'eft 


POSTSCRIPT, 

efl  argument  agajnft  it  is,  that  the  direft  contrary  is 
the  real  fa& ;  namely,  that  this  fever  does  not  take 
place  in  that  general  manner  which  from  the  aflign- 
ed  caufes  it  ought  to  do.  From  my  own  obferva- 
tion  I  have  long  been  thoroughly  convinced  of 
this  ;  however,  tp  afcertain  the  fa 61;  with  all  pofli- 
ble  precifion,  I  have  written  to  perfons  of  the  firft 
eminence  in  the  profeflion  in  many  principal  towns 
throughout  thefe  kingdoms,  to  feveral  of  whom 
this  diforder  is  totally  unknown.  A  gentleman 
defervedly  of  great  eminence,  who  has  had  ample 
experience  of  this  fever  in  London,  informs  me 
that  he  praclifed  midwifery  many  years  in  one  of 
the  inland  counties,  and  never  met  with  that  fever 
whilft  he  refided  there. 


Being  informed  that  the  puerperal  fever  was  al- 
moft  as  common  and  as  fatal  at  Northampton  as 
jn  London,  I  was  dcfirous,  if  poffible,  of  finding 
out  the  caufe,  and  I  have  been  favoured  with  the 
following  account  from  a  gentleman  of  diftinguifti- 
ed  abilities  in  that  place.  He  informs  me,  that 
<*  when  the  lying  in  women  are  committed  folely 
"  to  nurfes,  they  are  generally  kept  in  a  clofe  warm 
"  room,  and  plentifully  fupplied  with  wine  or  beer 
"  caudle,  with  aromatics;  fometimes  even  gin  and 
"  other  fpirituous  liquors,  efpecially  among  the 
"  lower  clafs  of  women,  are  prepofteroufly  admin- 
^  iftered.  They  generally  keep  lying  in  women 

"  in 


234  POSTSCRIPT. 

"  in  bed  four  or  five  days  after  delivery.  Where 
<e  the  faculty  are  concerned,  a  cooler  and  more  tem- 
"  perate  regimen  is  obferved,  and  the  patient  al- 
<(  lowed  to  fit  up  the  third  day  after  delivery.'* 

I  have  juft  now  been  favoured  with  a  letter  froni 
Dr.  Young,  Profeffbr  of  Midwifery  at  Edinburgh, 
who  is  not  only  poffeffed  of  a  principal  fhare  of 
private  pra&ice  in  that  branch,  but  has  the  fble 
direction  of  a  lying  in  ward  in  the  Royal  Infirma- 
ry in  that  city.  Speaking  of  the  puerperal  fever, 
he  fays,  "  We  have  no  fuch  fever,  and,  excepting 
"  one  woman  who  died  in  the  lying  in  ward,  feem- 
"  ingly  of  a  mortification  after  a  very  fevere  la* 
"  bour,  I  have  not  loft  one  patient  after  delivery 
"  for  fome  time, 

"  I  have  within  there  few  years  made  a  very 
u  great  change  upon  the  method  of  treating  worn- 
"  en  after  delivery  in  this  place,  which  was  before 
"  entirely  in  the  hands  of  the  women.  The  lying 
"  in  women  are  kept  almoft  as  cool  as  thofe  who 
"  are  inoculated  for  the  fmall  pox,  and  they  cer* 
"  tainly  recover  much  fafter." 

By  Dr.  Price's  obfervations,  and  by  the  bills  of 
mortality,  it  appears  that  in  Edinburgh  the  proba- 
bility of  a  human  life  is  as  low  as  in  London,  and 
much  worfe  than  in  Dublm,  Manchefler,  or  North- 
ampton : 


POSTSCRIPT.  235 

. 

atnpton  :  and  though  this  laft  named  town  is  the 
fmalleft  of  the  five,  and  more  healthful  in  other 
refpe&s,  yet  the  puerperal  fever,  by  the  beft  ac- 
counts I  have  been  able  to  obtain,  is  almoft  as  fa- 
tal there  as  in  London,  and  much  more  fo  than  in 
any  of, the  other  towns  I  have  mentioned. 

In  London  the  puerperal  fever  was  obferved  by 
fpme  to  be  more  fatal  in  the  year   1770,   than  in 
any  other  year  ;  but  I  do  not  find  that  the  fame  ob- 
fervation  held  good  invariably  either  there  or  in 
other  places.     The  fatality  that  attends  the  patients 
in  fome  of  the  lying  in  hofpitals,   greatly  exceeds 
that  of  any  private  practice,  at  leaft  any  that  I  have 
been  acquainted  with.     In  one  publick  lying  in 
hofpital,  from  the  firil  opening  on  the  2Oth  of  A- 
pril  1767,  to  the  2gth  of  November  1772,  653 
women  have  been    delivered,   of  whom    18    died, 
which  is  more  than  one  in  36 ;  in  this  hofpital  the 
beginning  of  the  year  1770  was  particularly  unfa- 
vourable ;  for  out  of  63  women  who  were  deliver- 
ed betwixt  the  3Oth  of  November   1779  and  the 
15th  of  May  1770,  14  died,  which  is  in  the  pro- 
portion of  one  in  4^.     In  the  printed  accounts  of 
another  lying  in  hofpital  from  its  firft  inftitution 
in  November  1749  to  the  3ift  of  December  1770, 
there  were  9108  delivered,  of  whom   196  died  in 
the  hofpital  after  delivery,  which  is  neareft  one 
|n  46!  ;  out  of  the  number,  890  were  delivered  in 

the 


P  Q  S  T  S  C  R  J  P  T. 

the  year  1779,  and  35  died,  whicfe  js  more  thait 
the  proportion  of  one  in  25  J  ;  the  year  1760  was 
likewife  very  unfavourable  to  this  hofpital.  In 
another  hofpital  there  have  been  fince  the  begin- 
ning of  the  year  1747  to  the  prefent  time,  4758 
women  delivered,  and  93  have  died,  which  is  about 
the  proportion  of  one  in  51.  The  year  1771  was 
the  moft  unfavourable  to  the  lying  in  women  in 
this  hofpital,  for  out  of  282  delivered  that  year,  10 
died,  which  is  about  the  proportion  of  one  in  28. 
In  another  lying  in  hofpital  I  am  informed,  that 
the  year  1770  was  not  unfavourable  to  the  child- 
bed women,  but  the  year  1771  was.  But  this  gen- 
eral fatality  does  not  feem  to  have  attended  every 
lying  in  hofpital  in  London,  for  in  one  inftituted 
about  fix  years  ago,  790  women  have  been  deliv- 
ered, and  only  fix  have  died,  viz.  two  of  the  puer- 
peral fever,  one  in  the  year  1770,  the  other  in 
1771  ;  three  of  floodings  ;  and  one  of  a  confump- 
tion,  which  is  no  more  than  one  in  1312-3. 

In  the  lying  in  hofpital  in  George's  lane,  Dub- 
lin, from  March  1745  to  the  firft  of  October  1754, 
there  were  delivered  3206  women,  and  29  died, 
which  is  about  the  proportion  of  one  in 


In  the  new  lying  in  hofpital  in  Great  Britain  ftreet, 
Dublin,  from  the  opening  on  the  8th  of  December 
*757>  to  tne  3*ft  of  October  1775,  there  have  been 

delivered 


POSTSCRIPT.  237 

delivered  in  the  hofpital  10726  women,  of  whom 
152  have  died,  which  is  nearly  one  in  70.  In 
this  hofpital,  fa  the  year  1768,  633  women  werq 
delivered,  and  feventeen  died,  which  is  nearly  one 
in  37.  In  the  year  1770,  6i6  were  delivered,  and 
only  five  died,  which  is  one  in  135.  Therefore, 
though  it  appears  that  the  year  1770  was  very  fa- 
tal to  the  women  in  fome  of  the  lying  in  hofpitals 
in  London,  yet  it  was  remarkably  otherwife  in  the 
lying  in  hofpital  in  Dublin,  and  the  year  1768  was 
the  moft  fatal  in  that  hofpital. 

It  is  worthy  of  obfervation  of  two  hofpitals,  both 
fituated  at  nearly  equal  diflances  from  the  centre 
of  the  fame  city,  viz.  London,  both  inftituted  a- 
bout  the  fame  period  of  time,  and  both  under  the 
direction  of  men  of  confiderable  eminence  in  the 
profeflion,  and  nearly  the  fame  number  of  women 
having  been  delivered  in  both  hoiifes  ;  that  in  one 
of  them,  they  mould  lofe  in  the  proportion  of  one 
in  36,  and  in  the  other  only  one  in  131  2-3. 

In  order  to  inform  both  myfelf  and  the  public 
of  every  matter  relative  to  fo  important  a  point,  I 
have  made  farther  inquiry  into  the  caufe  of  the 
great  fuccefs  of  this  particular  hofpital,  and  I  am 
favoured  with  the  following  account  by  a  gentle- 
man who  has  eminently  diilinguimed  himfelf  for 
bis  knowledge  in  this  branch  of  practice.  He  in- 

»  forms 


238  POSTSCRIPT. 

forms  me,  that  "  This  Jhofpital  is  fituated  neai% 
"and  open  to  the  fields;  no  particular  care  is 
"  taken  of  their  diet  or  regimen  in  any  refpeft, 
"  but  there  are  fcarcely  ever  more  than  f6ur  in  the 
11  fame  room,  commonly  two  only  ;  and  it  is  to 
"  the  open  air  and  the  confinement  of  fo  few  in 
"  one  room  that  we  impute  the  fuccefs. 

"  Whereas  in  another  hofpital  there  are  eighteen 
"  or  twenty  in  a  room,  which  ought  only  to  re- 
"  ceive  eight." 

Perhaps  there  are  fome  other  particulars  relative 
to  this  hofpital  which  may  contribute  very  materi- 
ally to  its  fuccefs.  It  was  inftituted  for  the  pur- 
pofe  of  inftru&ing  young  gentlemen,  and  not  only 
unmarried  women,  but  even  thofe  of  the  mod  a- 
bandoned  chara£lers  are  admitted.  It  is  not  to  be 
fuppofed  that  in  an  hofpital  of  this  kind  unnecef- 
fary  expenfes  of  any  fort  are  fuffered  to  be  incur- 
red either  in  nurfing  or  diet,  and  the  patients  are 
therefore  obliged  to  do  a  good  deal  for  themfelves  ; 
add  to  this,  that  thefe  fort  of  women^are  of  great 
fpirits,  impatient  of  confinement,  and  will  not  fub- 
znit  to  it  longer  than  they  can  poffibly  avoid. 

I  have  endeavoured  to  form  a  calculation  of  the 
proportion  of  women  who  have  died  in  childbed 
to  thofe  who  have  been  delivered,  in  different 

towns,. 


POSTSCRIPT,  239 

towns,  viz.  London,  Northampton,  Mancheflerr 
Holy  Crofs  in  Salop,  Chefter,  Warrington,  Liver- 
pool, Ackworth  near  Ferrybridge,  Yorklhire,  and 
feveral  places  in  Germany  ;  it  is  not  in  my  power  to 
do  this  with  precifion,  as  we  cannot  exactly  deter- 
mine the  number  of  women  who  have  been  delivered 
every  year  in  each  town  :  However,  from  compar- 
ing the  number  of  chriftenings  with  the  number  of 
women  who  have  died  in  childbed,  as  taken  from 
the  bills  of  Mortality  of  thefe  different  towns  for 
feveral  years  laft  paft,  we  may  form  fome  proba* 
ble  conjecture.  Yet  if  we  make  proper  allowance^ 
for  the  ftillborn  and  chrifoms,  we  mall  find  that 
the  number  of  women  delivered  each  year  will 
greatly  exceed  the  chriftenings,  therefore  the  fuc- 
cefs  of  general  practice  will  be  much  greater  than 
is  here  reprefented. 

In  Manchefter,  regifters  of  particular  difeafes 
have  been  kept  no  longer  than  eighteen  years,  and 
in  the  collegiate  church  only.  Thefe  I  have  di- 
vided into  three  periods,  in  order  to  mew  that 
though  the  town  has  in;creafed  in  fize  and  number 
of  inhabitants,  yet  the  danger  attending  childbed 
women  has  been  diminifhed,  which  muft  chiefly 
be  owing  to  the  improvements  in  the  management 
of  them.  It  is  to  be  lamented  that  thefe  regiftevs 
have  not  been  longer  kept,  a«  the  fatal  period  I 
have  alluded  to  in  the  former  part  of  this  treatife 

when 


POSTSCRIPT. 

when  the  fatality  was  occasioned  by  mifmanage- 
ment,  was  prior  to  that  time,  during  which  period 
from  my  own  recollection,  I  am  very  certain  the 
misfortunes  attending  childbed  women  would 
greatly  have  exceeded  the  following  calculations. 

In  London,  from  the  beginning  of  the  year  1737 
to  the  end  of  the  year  1753,  being  17  years,  there 
were  254252  chriftenings,  and  3552  women  died 
in  childbed,  which  is  the  proportion  of  one  in  71^-. 
In  the ilaft- eighteen  years  there  were  281304  chrift- 
enirigs;  and  3905  women  died  in  childbed,  which  is 
in  the  proportion  of  one  in  72.  The  moft  fatal  years 
were  1761,  when  289  women  died  in  childbed,  and 
there  were  16000  chriftenings,  which  is  in  the  pro- 
portion of  one  in  55  ;  and  the  year  1762,  when 
272  died  in  childbed,  and  there  were  15321  chrift- 
enings which  is  in  the  proportion  of  one  in  56. 
The  year  1771  was  the  moft  favourable,  when  172 
women  only  died  in  childbed,  and  there  were 
17072  chriftenings,  which  is  in  the  proportion  of 
one  in  99. 

In  Northampton,  ifi  the  parifh  of  Allfaints, 
from  the  beginning  of  the  year  1737  to  the  end  of 
the  year  1753,  there  were  1535  chriftenings,  dif. 
fenters  included,  and  20  women  died  in  childbed, 
which  is  in  the  proportion  of  one  in  76^.  In  the 
laft  eighteen  years  there  were  1602  chriftenings, 

and 


P  O  S  T  S  C  R  I  P  Tt 

and  20  women  died  in  childbed,  which  i*  in  the 
proportion  of  one  in  80. 

In  the  parifh  of  Holycrofs,  in  Salop*,  from 
Michaelmas  1750  to  Michaelmas  1760,  there  were 
331  chriflenings,  and  4  women  died  in  childbed, 
which  is  about  the  proportion  of  one  in  82. 
From  that  time  to  Michaelmas  17701*,  there  were 
382  chriflenings,  and  4  women  died  in  childbed, 
which  is  about  the  proportion  of  one  in  95. 

In  Manchefler,  at  the  collegiate  church,  from 
the  beginning  of  the  year  1754  to  the  end  of  the 
year  1759,  there  were  41 17  chriflenings,  and  44 
women  died  in  childbed,  which  is  about  the  pro- 
portion of  one  in  93.  From  that  time  to  the  end 
of  the  year  1765,  there  were  4432  chriflenings,  and 
40  women  died  in  childbed,  which  is  about  the 
proportion  of  one  in  nof.  In  the  lafl  fix  years 
there  were  5251  chriflenings,  and  47  women  died 
in  childbed,  which  is  nearefl  one  in  111^.  In  the 
year  1770  there  were  897  chriflenings,  and  eight 
women  died  in  childbed,  which  is  in  the  propor- 
tion of  one  in  112.  In  the  year  1771  there  were 
1001  chriflenings,  and  6  women  only  died  in  child- 
bed, which  is  one  in  167  ;  this  and  the  year  1759 
were  the  mofl  favourable  to  lying  in  women,  and 

the 

*  See  Phil,  Tranf.vo.l.  LII.  p.  i.  Art.  25, 
-Ubid.vol.  LXf.p,  i,Art,6, 

Q 


POSTSCRIP  T. 

the  year  1757  was  the  moft  unfavourable,  for  there 
were  only  593  chriftenings,  and  9  women  died  in 
childbed,  which  is  in  the  proportion  of  one  in  66. 

Thefe  calculations  are  not  however  entirely  to 
be  depended  on,  as  I  find  that  more  families  have 
their  children  chriftened  at  the  collegiate  church 
than  what  bury  there,  but  in  the  years  1772,  1773, 
and  1774,  very  accurate  accounts  were  taken  at  all 
the  churches  and  chapels  in  Mancheiter  and  Sal- 
ford,  by  which  it  appears  that  there  were  4035 
chriftenings,  and  44  women  died  in  childbed,  which 
is  nearly  in  the  proportion  of  one  in  91-J. 

' 

At  Chefter,  in  the  years  1772,  1773,  and  1774, 
there  were  1238  chriftenings,  and  13  women  died 
in  childbed,  which  is  in  the  proportion  of  one  in  95. 

At  Warrington,  in  the  years  1773,  1774,  and 
1775,  there.were  1124  chriftenings,  and  10  wom- 
en died  in  childbed,  which  is  nearly  one  in  112. 

At  Liverpool,  in  the  year  1772,  there  were  1108 
chriftenings,  and  1 1  women  died  in  childbed,  which 
is  nearly  in  the  proportion  of  one  in  100. 

At  Ackworth,  a  fmall  village  near  Ferrybridge 
iti  Yorkfhire,  from  the  8th  of  December  1744  to  the 
gift  of  December  1773,  being  29  years  and  a  few 

days, 

' 

' 


POSTSCRIPT.  243 

days,  there  were  559  chrilknings,  and  6  women 
died  in  childbed,  which  is  nearly  in  the  proportioa 
of  one  in  93. 

In  Leipfic,*  from  the  beginning  of  the  year 
1720  to  the  end  of  the  year  1725,  there  were  5237 
chriflenings,  and  107  women  died  in  childbed.  In 
Lobau,  in  1720,  160  were  born,  and  4  died  in  child- 
bed. In  St.  Annabergh,  105  were  born,  and  one 
died  in  childbed.  At  Schnubergh,  89  were  born, 
and  one  died  in  childbed.  At  Rawits,  134  were 
born,  and  15  died  in  childbed.  At  Ratifbon,  in 
1721,  250  were  chriflened,  and  2  died  in  childbed. 
At  Coburg,  in  1725,  206  were  chriflened,  and  2 
died  in  childbed.  Total  6181  chriftenings,  and 
132  women  died  in  childbed,  which  is  about  the 
proportion  of  one  in 


If  we  confider  that  the  poor  will  be  found  to 
conftitute  the  bulk  of  the  people  in  almoft  every 
town  ;  that  many  of  the  poor  women  when  in  la- 
bour have  very  ignorant  widwives,  forne  of  them 
much  worfe  than  none  at  all  ;  and  that  very  few 
of  them  can  be  attended  by  regular,  or  even  by  a- 
ny  mirfes,  but  are  obliged  to  take  care  of  them- 
felves,  deflitute  of  proper  affiftance,  and  of  even  the 
neceflaries  of  life,  and  perhaps  affli&ed  with  dan- 
gerous diforders  ;  if  under  all  thefe  difadvantages  it 
O  2  mould 

*  Martin's  Abridgment  of  the  Phil.  Tranf,  vol?  7.  fart  ^ 


244  POSTSCRIP  T, 

fhould  be  found  that  the  fuccefs  attending  them 
jfhould  be  greater  than  that  of  fome  private  pra&ice 
among  the  affluent,  or  even  the  pra&ice  in  fome 
lying  in  hofpkals,  where  all  proper  affiftance  is 
fuppofed  to  be  at  hand,  we  have  great  reafon  to 
apprehend  mifmanagement  in  fome  department  or 
other. 

It  may  perhaps  be  thought  neceffary  to  make 
fome  apology  for  thefe  calculations  and  compan- 
ions, efpecially  thofe  relating  to  hofpitals,  which 
are  given  with  no  other  view  than  to  the  improve- 
ment of  this  branch  of  medical  knowledge.  I  en- 
tertain the  highefl  opinion  of  hofpitals  and  infirma- 
ries, efpecially  thofe  which  are  maintained,  by  vol- 
untary fubfcriptions.  They  are  the  nobleft  of  all 
charities,  the  lead  liable  to  abufe,  and  if  it  happen 
that  fome  of  them  have  not  been  fo  fuccefsful  as 
others,  the  evil  needs  only  to  be  pointed  out,  and 
I  have  no  doubt  but  it  will  be  remedied. 

The  buffy  or  lizy  appearance  of  the  blood  in 
the  puerperal  fever  is  brought  to  fhow  that  it  is  an 
inflammatory  diforder  ;  but  fometimes  the  blood 
drawn  from  fuch  patients  does  not  coagulate  ort 
being  expofed  to  the  air,  as  in  the  cafe  which  Mr. 
Hewfon  *  mentions  of  a  patient  in  the  Britifh  ly« 
ing  in  hofpital.  The  blood  was  drawn  three  days 

before 

*  Experimental  Inquiry,  p«  lit..     , 


POSTSCRIPT.  245 

before  her  death,  and  Mr.  Hewfon  has  been  fo 
kind  as  to  inform  me  that  this  patient  was  judged 
to  have  a  true  puerperal  fever,  as  was  evident  both 
from  her  fymptoms  and  from  diffe&ion  :  and  pof- 
fibly  the  blood  might  oftener  have  the  fame  ap- 
pearance if  patients  were  bled  late  in  this  diforder. 
Mofl  pregnant  women  have  iizy  blood  where  there 
are  no  fyrnptoms  of  inflammation. 

Sir  John  Pringle,  Dr.  Huxham,  and  others  have 
obferved  that  in  putrid  fevers  the  appearance  of 
the  blood  is  very  various  :  fometimes,  efpecially 
in  the  beginning  of  the  difeafe,  mowing  an  inflam* 
matory  cruft,  and  very  foon  changing  to  a  famous 
and  diffolved  ftate,  fo  that  no  certain  indications 
can  be  drawn  from  it. 

With  refpecl:  to  bleeding  in  the  puerperal  fever, 
I  cannot  upon  the  ftri&eft  inquiry  find  that  thofe 
who  have  bled  the  moft  copioufly  have  had  the 
beft  fuccefs,  either  in  private  or  in  hofpital  prac- 
tice. Dr.  Hulme  fays,  "  Bleeding  mould  only  be 
"  looked  upon  as  a  fecondary  help,  though  it 
•'-'•  fhould  always  be  firfl  in  point  of  time."  Thus 
far  he  is  certainly  right,  if  it  be  advifeable  at  all; 
but  I  muft  own  I  have  great  doubts  even  about  that 
in  all  cafes  indifcrimmately.  Emetics,  cathartics, 
and  clyfters  are  certainly  proper  to  cleanfe  the 
primx  via?,  and  likewife  fuch  medicines  and  diet  as 
Q  3 


246  POSTSCRIPT, 

will  correct  the  putrid  colluvies  ;  but  an  upright 
pofture  and  free  ventilation  are  at  all  times  ufeful, 
and  abfolutely  neceffary,  both  in  the  prevention 

and  cure. 

My  patients  generally  fit  up  in  bed  in  a  few 
hours  after  delivery,  fome  of  them  get  out  of  bed 
the  fame  day,  moft  on  the  fecond,  and  none  exceed 
the  third  ;  and  left  any  inconvenience  fhould  be 
fuppofed  to  arife  from  this  early  upright  pofture, 
I  think  it  neceffary  to  declare  that  none  whom  I 
have  delivered,  are  troubled  with  any  prolapfus  vag- 
ina;, or  any  other  complaint  which  I  have  the  leaft 
reafon  to  fufpeft  could  pofiibly  arife  from  fuch 
treatment. 

Several  difficulties  which  arife  concerning  the 
puerperal  fever  may,  I  imagine,  be  more  confiftent- 
ly  and  fatisfa&orily  anfwered  from  the  ideas  I  have 
attempted  to  give  of  it  than  from  any  others.  <;  Why 
is  this  fever  more  common  and  fatal  in  fome  fea- 
fons  than  in  others,  under  the  fame  management 
of  lying  in  women  ?  This  muft  proceed  from  the 
different  difpofition  of  the  air  to  favour  putrid  dif- 
orders  which  from  various  obfervations  we  know 
frequently  takes  place.  £  Why  in  the  very  fame 
ward  of  an  hofpital,  and  under  apparently  fimilar 
circumftances,  fhould  fome  be  fatally  attacked  with 
fever,  and  others  entirely  efcape  ?  This  is  no 

more 


POSTSCRIPT.  247 

more  than  what  we  fee  every  day  to  be  the  cafe 
even  in  diforders  which  are  the  mofl  infectious, 
which  fhows  us  that  all  perfons  are  not  equally  lia- 
ble to  the  fame  difeafe,  nor  the  fame  perfon  at  dif- 
ferent times  and  feafons.  <;  Why  does  not  the  foul 
air  affect  patients  in  the  lying  in  hofpitals  before 
delivery  as  well  as  after  ?  This  feems  nearly  to  re- 
femble  what  happens  in  ill  ventilated  hofpitals 
where  patients  with  large  abfceffes,  white  fwellings 
of  the  joints,  and  the  like,  frequently  efcape  fevers 
till  the  abfceffes  are  opened  or  the  limbs  amputated, 
and  are  then  immediately  feized  with  putrid  ones 
which  foon  deftroy  them  ;  both  probably  are  ow- 
ing to  the  fame  immediate  caufe,  viz.  the  admiffion 
of  air  to  the  difcharges,  which  are  either  already 
putrid,  or  will  foon  become  fo  on  the  accefs  of  the 
air,  in  which  cafe  the  putrid  matter  will  be  readily 
abforbed  by  the  lymphatics,  now  open  to  receive  it. 
I  am  informed,  that  in  an  hofpital  in  London  much 
crowded  with  patients,  the  furgeons  obferved  that 
all  thofe  who  had  large  lumbar  abfceffes,  as  foon 
as  a  confiderable  opening  was  made  into  them,  were 
immediately  feifed  with  putrid  fevers,  and  died  in 
a  few  days,  though  they  were  in  tolerable  health 
before  the  opening  was  made  ;  this  put  them  up* 
on  an  experiment  of  letting  off  the  matter  gradu- 
ally by  a  fmall  trocar,  and  fome  days  afterwards 
introducing  a  feton :  The  event  was  however  the 
fame  in  the  end,  only  with  this  difference,  that 
9  4  thefe 


POSTSCRIPT. 

thefc  laft  named  patients  were  not  attacked  fo  fud- 
denly,  and  lived  fomething  longer  ;  but  as  foon  as 
the  foul  air  had  free  admittance,  the  fame  putrid 
fever  came  on  with  the  fame  fatal  effects.  Differ- 
ent degrees  of  putridity  will  affect  perfons  in  differ- 
ent ftates.  Lying  in  women  are  injured  by  a  fmall 
quantity  of  foul  air  fooner  perhaps  than  any  other 
patients  ;  a  fecond  degree  will  affect  thofe  who 
have  wounds  or  ulcers  internally  or  externally :  A 
further  degree  will  give  a  putrid  fever  to  perfons  in 
perfect  health,  as  frequently  happens  in  jails,  hof- 
pitals,  and  crowded  barracks ;  and  there  is  a  high- 
er degree  that  will  prove  fatal  in  a  few  hours  to  the 
ftrongeft  conftitutions,  as  in  the  cafe  of  our  unfor- 
tunate countrymen  at  Calcutta.  From  hence  we 
may  infer  why  the  puerperal  fever  is  always  attend- 
ed with  pain  and  tendernefs  in  the  hypogaftric  or 
iliac  regions,  and  frequently  upon  the  fymphylis 
of  the  pubis.  Becaufe  thefe  parts  lie  neareft  to  the 

uterus  and  inteftines,  and  are  therefore  moft  likely 

&  *  *- 
to  abforb  the  putrid  matter.     ^  Why  is  the  lower 

part  of  the  omentum  generally  mortified  ?  Becaufe 
it  lies  in  contact  both  with  the  uterus  and  in- 
teftines, and  from  its  adipofe  nature  foon  acquires 
a  gangrenous  date. 

Upon  the  whole,  I  am  difpofcd  to  conclude, 
that  though  inflammation  and  mortification  in  fome 
of  the  yifcera  have  often  been  difcovered,  upondif. 

fection, 


POSTSCRIPT. 

fefiion,  in  thofe  who  have  died  of  this  fever,  yet 
thefe  appearances  fhould  rather  be  confidered  as  the 
effe6t,  than  the  caufe.  That  the  immediate  caufe 
is  the  abforption  of  aerid  matter  from  the  intef- 
tines  and  uterus ;  and  frequently  a  depofition  of  it 
upon  the  omentum,  peritoneum,  or  fome  of  the 
vifcera  ;  and  the  predifpofing  caufes  are  accumu- 
lations of  feces  in  the  inteflines  ;  a  flagnation  of 
the  lochia  occafionedby  a  horizontal  pofition,  and 
want  of  free  ventilation  at  a  time  when  the  woman 
ftands  moil  in  need  of  it :  Under  thefe  circumftanc- 
es  it  may  happen  either  to  the  rich  or  the  poor.  As 
much,  therefore,  may  depend  upon  the  nurfes,  both 
in  public  and  in  private  practice,  it  is  earneflly  to 
be  wiflied,  that  accoucheurs  would  be  very  explicit 
in  their  directions,  and  that  patients  would  not  pay 
too  blind  a  deference  to  the  nurfes  when  they  aft 
contrary  to  the  advice  of  thofe  whofe  knowledge  is 
certainly  fuperior,  and  whofe  province  it  is  to  di- 
reft. 

I  had  finifhed  this  poftfcript  before  two  papers 
containing  fome  important  information  came  to 
hand,  the  fubftance  of  which  I  am  therefore  obliged 
to  infer t  here. 

The  firft  was  a  MS.  copy  of  Dr.  Hunter's  ex- 
cellent ledures  on  the  gravid  uterus,  which  I 
fliould  very  gladly  have  referred  to  in  the  body  of 

my 


250  POSTSCRIPT. 

my  treatife  to  fupport,  by  fo  refpeftable  an  author-* 
ty,  my  ideas  of  the  power  of  nature  in  accomplifh- 
ing  the  work  of  delivery  in  moft  cafes  without  the 
help  of  art,  and  the  neceffity  of  clofely  attending 
to  her  operations  in  laying  down  rules  for  the 
fafeft  and  eafieft  pra&ice.  The  Do&or,  however, 
gives  his  pupils  a  dreadful  account  of  the  puerpe- 
ral fever.  He  informs  them  that  he  has  unfortu- 
nately feen  a  great  deal  of  it  in  the  hofpital,  par- 
ticularly in  one  year,  when  it  was  fo  fatal  that  all 
the  gentlemen  attending,  and  all  the  patrons  of  the 
charity,  held  a  confultation  to  debate  whether  the 
houfe  mould  not  be  (hut  up.  That  in  two  months 
thirty  two  patients  were  feized  with  the  fever,  of 
whom  only  one  recovered.  That  various  methods 
of  treatment  were  put  in  practice  ;  fome  from  the 
beginning  of  the  difeafe  were  bled,  fome  were 
treated  with  cooling  medicines,  others  with  warm 
medicines  and  cordials,  but  every  thing  proved 
equally  unfuccefsful.  In  private  practice  the  fa- 
tality was  very  great,  and  at  lead  three  in  four  who 
were  attacked  with  the  fever,  died. 

The  other  piece  of  information  I  received  was 
contained  in  a  letter  with  which  I  was  favoured  by 
Prof e {for  Young  of  Edinburgh.  It  relates  to  the 
lying  in  ward  at  the  infirmary  in  that  city,  and 
when  compared  with  the  account  before  given  of 
the  fuccefs  attending  it,  will  ferve  to  confirm  the 

dire&ions 


POSTSCRIPT. 

dire&ions   I  offered  concerning  the  conflruftion 
and  mangement  of  thefe  hofpitals. 

The  lying  in  ward  at  Edinburgh  infirmary  is  a 
very  large  room  which  holds  ten  beds.  There  is 
but  one  fire  place,  which  is  at  one  end  of  the 
room  ;  and  the  door,  which  is  almoft  always  open, 
and  is  on  the  head  of  the  ftaircafe,  where  there  is  a 
conftant  ventilation,  is  placed  at  the  oppofite  end. 
As  the  ward  is  fubjecl:  to  fmoke,  a  window  near 
the  door  is  frequently  open.  There  are  ten  win- 
dows, and  the  height  of  the  room  is  about  fourteen 
feet.  The  women  have  all  lingle  beds  at  fome 
diftance  from  each  other.  They  generally  get  up 
on  the  fecond  or  third  day,  and  are  difmifTed  about 
a  fortnight  after  delivery,  fometimes  fooner  where 
they  have  families  which  require  their  care. 

Other  circumftances  attending  this  ward  may 
deferve  notice.  No  patients  are  received  from  the 
middle  of  July  to  the  i2th  of  November,  by  which 
means  it  is  fufficiently  purified  every  year.  None 
are  admitted  but  fuch  as  will  fubmit  to  be  deliver- 
ed by  the  fludents  ;  therefore  the  fame  reafons  may 
concur  here  which  are  mentioned  in  page  238,  as 
probably  contributing  to  the  fuccefs  of  a  particu- 
lar hofpital  in  London. 


APPENDIX. 


APPENDIX 


TO     THE 


SECOND    EDITION, 


*"  |  ~* 
1  HE  moft    material    improvements 

which  the  preceding  Volume  has,  I  flatter  myfelf, 
been  a  means  of  introducing  into  the  management 
of  pregnant  and  lying  in  women,  are  the  follow- 
ing :  ift.  The  ufe  of  a  cold  or  temperate  bath  dur- 
ing the  flate,  of  pregnancy,  and  that  of  giving  fuck, 
sdly.  Permitting  the  fhoulders  of  the  child  to  be 
expelled  by  the  labour  pains  only,  inftead  of  hur- 
rying them  away  forcibly  in  one  direction  without 
fufFering  them  to  accommodate  themfelves  to  the 
dimenfions  of  the  pelvis  by  making  their  proper 
turns.  sdly.  Allowing  the  circulation  between 
the  child  and  placenta  to  ceafe  fpontaneoufly,  in- 
ftead of  immediately  intercepting  it,  as  foon  as  the 

child 


APPENDIX,  253 

child  is  delivered,  by  tying  the  navel  firing.  4thly. 
Placing  the  woman  in  an  upright  pofition  as  early 
after  delivery,  and  as  frequently,  as  poffible.  Thefe 
are  all  points  which  deferve  an  attentive  confider- 
ation  ;  and  as  an  additional  experience  of  four 
years  has  enabled  me  to  fpeak  of  them  with  ftill 
greater  confidence,  and  to  enforce  them  by  later 
obfervations,  I  mall  include  what  I  have  farther  to 
communicate  on  thefe  fubje&s,  together  with  fome 
additional  remarks  upon  the  puerperal  fever,  in  an 
appendix. 

I.  In  the  body  of  this  work  I  have  flrongly  rec- 
ommended the  ufe  of  the  cold,  or  rather  temper- 
ate bath,  in  preventing  mifcarriages,  and  many 
other  diforders  incident  to  the  pregnant  ftate.  I 
can  now  confirm  the  efficacy  of  this  preventive 
remedy  from  ample  experience,  in  a  great  number 
of  different  conflitutions.  So  efficacious,  indeed, 
it  has  proved,  that  I  have  not  known  a  fingle  in- 
(lance  of  its  failure,  except  where  the  patient  has- 
received  fome  violent  injury.  This  was  the  cafe 
with  a  lady  who  mifcarried  in  confequence  of  a 
fall  down  flairs  ;  but  returning  afterwards  to  the 
ufe  of  the  bath,  me  conceived  again  ;  and  continu- 
ing the  bathing  the  whole  period  of  geftation,  be- 
came the  happy  mother  of  a  fine  child,  though  fhe 
had  before  met  with  frequent  difappointments. 

i 


*54  APPENDIX. 

I  muft  here  likewife  confirm  what  I  before  ob~ 
ferved  concerning  the  excellent  effects  of  the  fame 
remedy  in  increafing  the  fecretion  of  milk,  and 
preferving  the  health  during  the  time  of  fuckling  ; 
and  particularly  in  preventing  the  colds  to  which 
nurfes  are  fo  liable.  Several  ladies  of  my  ac- 
quaintance are  fo  fenfible  of  thefe  benefits,  that 
they  con (lantly  bathe  three  or  four  times  a  week 
while  pregnant  and  giving  fuck,  intermitting  it  on- 
ly during  the  month  of  their  lying  in,  and  fome 
icarcely  fo  long. 

It  is  a  jufl  and  important  obfervation  which  Dr. 
Hunter  makes  in  his  le&ures,  that  "  although 
women  ufually  mifcarry  at  eleven  or  twelve  weeks, 
the  fetus  has  generally  been  blighted,  or  removed 
out  of  the  circulation  at  feven  or  eight  weeks." 
This  fa€fc  fuggefts  an  effential  remark  concerning 
bathing,  that  if  it  be  not  begun  before  the  term  at 
which  the  uterine  fruit  is  generally  blighted,  no 
good  can  be  expected  from  it  in  preventing  mif- 


carnage. 


II.  The  common  practice  of  pulling  at  the 
child's  head  the  inftant  it  is  born,  and  thereby  pre- 
venting the  moulders  from  making  their  proper 
^urns,  is  produftiveof  more  bad  confequences  both 
to  the  mother  and  child  than  might  at  firfl  be  ap- 
prehended. The  child  is  a  fufferer,  as  well  by 

overftraining 


APPENDIX.  255 

overftraining  the  mufcles  of  the  neck  in  the  aftion 
of  forcibly  dragging  it  forwards,  as  by  the  pref- 
fure  of  the  fhoulders  againft  each  fide  of  the  cheft, 
whilft  they  pafs  through  the  bones  of  the  pelvis  in 
a  wrong  direction.  It  is  obvious  that  by  thefe 
means  its  fhape  will  be  greatly  altered,  perhaps  fo 
as  never  perfectly  to  recover  itfelf  ;  which  may  lay 
the  foundation  of  various  difeafes.  The  effe&s  on 
the  mother  are  probably  more  pernicious  in 
ftretching  and  relaxing  the  ligaments  of  the 
womb,  the  internal  coat  of  the  vagina,  and  the 
other  parts  fubfervient  to  generation  :  Whereby 
prolapfufes  of  the  vagina  and  anus,  and  a  train  of 
other  difagreeable  complaints  may  be  occafioned. 
But  there  are,  I  am  perfuaded,  more  immediate 
bad  confequences  accruing  to  the  mother.  By 
foreftalling  nature  in  the  expulfion  of  the  child, 
the  pains  are  fo  weakened  as  to  be  rendered  infuf- 
ficient  to  expel  the  placenta.  Before  I  became  fen- 
fible  of  the  abfurdity  of  this  mode  of  practice,  I 
was  frequently  obliged  to  extra 61  the  placenta  by 
manual  operation ;  but  for  many  years  pad  this 
has  never  happened  to  me  in  any  cafe  where  I  my- 
felf  had  delivered  the  child.  Gently  pulling  at  the 
funis  has  always  proved  fufficient  for  the  purpofe ; 
and  from  analogical  reafoning  I  (hall  conclude  that 
even  this  flight  afliftance  would  be  unneceffary, 
were  not  the  generality  of  women  in  our  age  and 
country  in  a  ftate  very  unfavourable  to  the  full  ex- 
ertion 


256  APPENDIX. 

ertion  of  their  natural  powers.  By  the  too  hafty 
delivery  of  the  child  likewife,  afterpains  are  occa- 
fioned,  as  by  this  means  the  mouths  of  the  finufes  or 
uterine  veins  are  permitted  to  clofe  too  fuddenly. 

III.  In  the  year  1775,  a  gentleman  in  London, 
of  deferved  eminence  in  his  profeflion,  printed  a 
ihort  paper  which  he  intended  to  put  into  the 
hands  of  every  practitioner  of  midwifery  with 
whom  he  was  acquainted.  Its  purport  was  to  rec- 
ommend a  method,  which  he  fuppofed  to  be  new, 
of  managing  the  navel  firing  at  the  time  of  deliv- 
ery. He  had  communicated  his  obfervations  on 
this  head  to  his  pupils  the  winter  before  ;  and  had 
Ihewn  the  paper  in  manufcript  to  feveral  medical 
gentlemen,  who  all  approved  of  it,  as  inculcating 
a  new  and  ufeful  mode  of  praclice.  A  few  days 
after  the  paper  was  printed,  he  was  much  furprifed 
when  fhewn  by  a  ftudent  that  I  had  recommended 
in  fuch  explicit  terms,  and  from,umilar  motives, 
the  fame  practice.  He  immediately  wrote  me  a 
very  friendly  letter,  with  a  relation  of  the  matter, 
and  inclofed  one  of  the  papers.  As  many  of  my 
readers  may  not  have  feen  this  little  tra&,  and  the 
point  propofed  is  very  ingenioufly  maintained  by 
the  author,  I  (hall  without  apology  reprint  it 
entire. 

. 

.AN 


A-PTPE  N-D-I-X. 

• 


AN  OBSERVATION  ON   THE  MANAGEMENT 

OJT  CHILDREN  AT  THE  TIME  OF  BIRTH. 

• 


•  '  : 

T  •    '  •  :  •  :'J  • 

:c  IT  bath  been  a  matter  :of  the  molt  ten- 

ous  confideration  to  thofe  who  have  had  the  care 
of  very  young  children,  to  fee  fo  great  a  number 
born  dead,  or  die  after  an  imperfect  exiftence  of  a 
few  hours  or  days.  Witlx,,a  view,  of  preventing 
thefe  accidents,  which,  though  fometimes  unavoid- 
able, have  more  frequently  fcerned  to  be  owing 
to  mif  management,  I  prefurue  to  recommend 
a  method,  which,  as  far  as  my  experience  enables 
me  to  judge,  is  much  preferable  to  that  which-  is 
ufually  followed/' 

• 
"  To  explain  my  opinion,  I  will  call  the  life  of 

a  child  in  utero  fetal  life,  and  the  life  which  is  con- 
fequent  to  refpiration,  animal  life. 

I 

<J  From  very  hard  and  tedious  labours,  and  from 
otfoer  caufes,  children  will  fometim.es  be  born  with- 
R  out 


«58  A  P  P  E  N  D  I  X* 

out  any  apparent  figns  of  life.  But  if  we  apply 
the  hand  to  the  fide  ;  or  examine  the  navel  firing, 
we  fhall  often  be  fenfible  of  a  flrong  and  regular 
pulfation  in  the  heart,  or  in  the  arteries  of  the 
navel  firing. 

<{  Under  fuch  circumflances  it  hath  been  thought 
proper  to  treat  the  children  as  apople6lic  ;  and 
with  a  view  of  preventing  thofe  ill  confequences, 
which  were  apprehended  from  the  accumulation  of 
blood  in  the  brain,  it  has  been  judged  neceffary  to 
divide  the  navel  firing,  and  to  fuffer  the  veffels  to 
difcharge  a  fmall  quantity  of  blood. 

<f  This  method  I  have  repeatedly  tried,  and  the 
almoft  uniform  confequence  has  been  the  death  of 
the  child.  In  many  inflances,  when  children  have 
breathed  or  even  cried,  on  tying  the  navel  firing, 
they  have  drooped  and  died,  or  afterwards  have 
been  recovered  with  great  difficulty. 

"  Nor  fhall  we  be  furprifed  at  the  event,  if  we 
confider  that  in  fuch  a  flate  the  life  of  the  children 
was  merely  fetal,  in  the  fame  manner  as  if  they 

were  yet  in  utero* 
• 

"  By  dividing  or  tying  the  navel  firing,  the  fe- 
tal life  was  inflantly  and  entirely  deflroyed,  and 
the  children  not  having  acquired  animal  life,  mufl 
inevitably  periftu 

"The 


APPENDIX.  259 

"  The  fetal  life  and  the  animal  life,  never  exift 
in  perfe&ion  at  the  fame  time ;  but  as  the  animal 
life  improves,  the  former  gradually  declines,  and  is 
at  laft  deftroyed. 

"  Thus,  when  a  child  is  born  with  figns  of  the 
moil  perfect  life,  there  is  a  pulfation  in  the  arte- 
ries of  the  navel  firing.  If  the  child  mould  contin- 
ue to  breathe  or  to  cry,  this  pulfation  abates,  and 
in  a  fhort  time  entirely  ceafes. 

"  Should  a  child  be  born  very  feeble,  and  nei- 
ther breathe  or  cry,  the  pulfation  of  the  arteries  of 
the  navel  firing  may  neverthelefs  be  often  perceiv- 
ed, till  the  child  acquires  perfect  animal  life,  or  till 
it  be  entirely  dead. 

"  It  is  curious  to  obferve  the  manner  in  which 
the  pulfation  of  the  arteries  of  the  navel  firing  de- 
clines. It  firfl  ceafes  in  that  part  which  is  neareft 
to  the  mother,  and  the  column  of  blood  is  thrown 
at  every  flroke  of  the  heart  of  the  child  to  a  lefs 
diflance  ;  fo  that  at  laft,  the  blood  which  circulat- 
ed in  the  fetal  part  of  the  placenta,  refides  in  the 
child. 

"  The   pulfation    of  the  arteries  of  the   navel 
ftring  proves  the  exiflence  of  the  fetal  life.     The 
of  the  fetal  life  proves  the  imperfeaion 
&2  of 


APPENDIX, 

of  the  animal  life.     While  the  animal  life  is  im- 
perfect, the  fetal  life  ought  not  to  be  deflroyed. 

"  The  navel  firing  therefore  fhould  never  be 
divided  or  tied,  while  there  is  any  pulfatio*i  in  its 
arteries. 

"  Another  method  has  bten  advifed  fof  the  re- 
covery of  children  born  apparently  dead.  Inftead 
of  dividing  the  navel  firing,  it  has  been  recom- 
mended to  prefs  the  blood  contained  in  it  from  the 
mother  towards  the  child. 

"  But  this  method  may  produce  inconveniences 
of  another  kind  ;  for,  if  much  force  be  ufed,  it 
feems  impoffible  abfolutely  to  prevent  or  to  fupprefs 
the  a&ion  of  the  heart  of  the  child.  As  we  are  ig- 
norant whether  the  inactivity  of  the  heart  proceeds 
from  a  defect  or  an  excefs  of  blood,  it  is  not  pru- 
dent to  interfere  with  the  efforts  or  proceedings  of 
nature,  left  we  fhould  impede  or  interrupt  rather 
than  forward  her  operations. 

"  I  have  only  confidered  the  treatment  of  chil- 
dren newly  born,  as  favourable  or  unfavourable  to 
their  immediate  recovery.  It  is  not  however  un- 
reafonable  to  fuppofe  that  the  wrong  management 
of  children  at  the  time  of  birth,  may  be  the  caufe  of 
of  the  difeafes  to  which  they  are  fubjeft. 

For 


APPENDIX, 

, 

For  if  they  are  prevented  from  acquiring  perfect 
animal  life,  and  are,  immediately  after  birth,  de* 
prived  of  a  certain  quantity  of  blood,  which  may, 
at  leaft,  be  e  deemed  the  medium  by  which  life  is 
preferved,  we  cannot  wonder  that  they  are  more 
liable  to  difeafes,  and  lefs  able  to  ftruggle  with  the 
attending  danger. 

"  I  mould  not  even  hefitate  to  declare  my  opin- 
ion, that  many  of  thofe  difeafes  of  more  advanced 
age,  which  have  been  efieemed  hereditary,  may 
have  been  occafioned  by  imprudent  management 
at  the  time  of  birth  :  For  thofe  conftitutions  muft 
neceflarily  be  infirm  which  were  never  in  pofleflion 
ofperfeftlife." 


IV.  The  prefence  or  abfe.nce  of  the  puerperal 
fever  being,  as  I  conceive,  very  nearly  connected 
with  the  maintenance  of  an  horizontal  or  an  up- 
right pofition  after  delivery,  I  mall  under  this 
head  comprife  what  I  have  to  add  concerning  both 
thefe  fubje&s. 

Writers  are  Mill  much  divided  in  their  opinions 
of  the  caufe,  and  even  of  the  nature  of  the  puer- 
p<#al  fever  ;  fome  ranking  it  under  the  clafs  of  in- 
flammatory, fome  of  putrid  difeafes,  fome  calling 
it  a  mixture  of  both,  and  fome  a  fever  fui  generis* 
The  very  attempt  to  clafs  it  has  been  attended 
R  3  with 


262  APPENDIX. 

with  Tome  difad vantages,  by  rendering  the  differ^ 
ence  of  opinion  concerning  it  greater,  and  what  is 
worfe,  by  influencing  practice.  Diffeftions  them- 
felves  have  not  afftfted  much  in  clearing  up  this 
matter,  as  the  appearances  have  not  been  always 
fimilar,  and  different  conclufions  have  been  drawn 
from  the  fame  appearances.*  It  is  obvious  that 
till  fome  greater  certainty  be  obtained  with  regard 
to  the  caufe  and  nature  of  this  difeafe,  all  attempts 

towards 

*  The  following  observations  of  my  worthy  friend  Mr.  J,  Hunter,  may 
not  perhaps  be  here  improperly  introduced. 

"  An  accurate  knowledge  of  the  appearances  in  animal  bodies  that  die  of 
'*'  a  violent  death,  that  is,  in  perfe6l  health,  or  in  a  found  ftate,  ought  to  be 
41  confidered  as  a  neceffary  foundation  for  judging  of  the  ftate  of  the  body  in 
"  thofe  thjjt  are  difeafcd. 

4t  But  as  an  animal  body  undergoes  changes  after  death,  or  when  dead,  it 
"  has  never  been  fufficiently  confidered  what  thofe  changes  are  ;  and  till 
"  this  be  done,  it  is  impoflible  we  fhould  judge  accurately  of  the  appear- 
41  ances  in  dead  bodies.  The  difeafcs  which  the  living  body  undergoes, 
*'  mortification  excepled,  are  always  connected  with  the  living  principle, 
"  and  are  not  in  the  leaft  fimiiar  to  what  may  be  called  difeafes  or  changes 
41  in  the  dead  body  :  Without  this  knowledge,  our  judgment  of  the  ap- 
*l  pearances  in  dead  bodies  muft  often  be  very  imperfeft,  or  very  errone- 
'*  ous  ;  we  may  fee  appearances  which  are  natural,  and  may  fuppofe  them 
*'  to  have  ariien  from  difeafe  ;  we  may  fee  difeafed  parts,  and  fuppofe  them. 
*'  in  a  natural  ftate  ;  and  we  may  fuppofe  a  circumftance  to  have  exifted  be- 
**  fore  death,  which  was  really  a  confequence  of  it  ;  or  we  may  imagine  it 
**  to  be  a  natural  change  after  death,  when  it  was  truly  a  difeafe  of  the  liv- 
.**  ing  body.  It  is  eafy  to  fee,  therefore,  how  a  man  in  this  ftate  of  igno- 
*'  ranee  muft  blunder,  when  he  comes  to  connefl  the  appearances  in  a  dead 
*'  body  with  the  fympioms  that  were  obferved  in  life  ;  and  indeed  all  the 
•*'  ufefulnefs  of  opening  dead  bodies  depends  upon  the  judgment  and  fa- 
.*'  gacity  with  which  this  fort  of  cornparifon  is  made."  Phil.  TranA  vol.  6c, 
p,  447  and  448, 


APPENDIX.  263 

towards  a  rational  method  of  prevention  or  cure 
will  be  vain. 

There  are,  however,  fome  particular  fymptoms 
attending  it,  which  if  accurately  inveftigated,  may 
greatly  affift  our  inquiries.  The  moft  diftinguiih- 
ing  and  infeparable  fymptom  of  all  others  is  the 
quicknefs  *  of  the  pulfe,  whatever  other  quality  be 

joined 

*  "  The  pulfe  has  almoftan  invariable  and  unufual  quicknefs  from  the  be- 
ginning." 

Dcnman. 

"  In  the  cold  fit  the  pulfe  was  quick  and  fmall,  and  the  pulfations  fo  fee- 
ble and  indiftinft,  that  fometimes  I  was  hardly  able  to  number  them  exactly. 
When  the  hot  fit  came  on,  though  it  was  then  more  full  and  diftinft,  it  ftill 
remained  quick,  but  was  feldom  hard  or  ftrong,  except  in  a  few  inftances, 
•where  the  patient  was  young  and  plethoric.  In  general,  it  would  beat  from 
ninety  to  one  hundred  and  thirty  feren  ftrokes  in  a  minute," 

Leake  on  the  Childbed  Fever,  &c.  p.  45  and  46. 

"  As  they  became  more  and  more  exhaufted,  and  within  a  few  hours  of 
death,  the  pulfe,  -which  was  exceedingly  quick,  and  almoft  imperceptibly 
weak,  at  laft  was  infenfibly  loft  in  a  tremulous  flutter." 

Ibid.  p.  50, 

"  The  pulfe  in  general,  is  quick  and  weak  ;  though  fometimes  it  will  r*. 
fift  the  finger  pretty  flrongly.  At  the  beginning  of  the  difeafe,  it  feldom 
beats  lefs  than  a  hundred  ftrokes  in  the  fpace  of  a  minute  ;  and  from  this 
number,  I  have  found  it  run  on  to  one  hundred  and  fixty." 

Hulme  on  the  Puerperal  Fever,  p,  5. 

"  Nay,  fo  infallible  is  the  beat  of  the  pulfe,  with  refpeft  to  number,  that 
though  all  the  other  fymptoms  mould  abate,  and  the  difeafe  feem  to  be  gone 
off,  yet  if  the  pulfations  do  not  decreafe  in  proportion,  a  relapfe,  or  fom« 
other  diforder,  is  to  be  feared.  ««  A 

R4 


264  APPENDIX. 

joined  to  it,  which  conftantly  occurs  whenever  this 
fever  exifts  in  any  alarming  degree ;  and  from 
which  the  degree  of  danger  may  be  eftimated  more 
certainly  than  from  all  the  other  fymptoms  put  to- 
gether. This  immoderate  quick  pulfe  is  not  the 
conftant  attendant  of  inflammatory,  putrid,  ner- 
vous, or  eruptive  fevers  ;  but  every  furgeon  con- 
verfant  with  bufmefs  knows  that  it  never  fails  to 
attend  abforprion  of  matter  from  abfceffes  or  ulcers, 
whatever  be  the  other  concomitant  fymptoms,  or 
the  quality  of  the  matter.  The  phyfician  alfo 
knotfs  it  is  conftantly  prefent  in  ulcers  of  the 
lungs,  and  other  internal  parts  of  the  body. 

In  lumbar  abfceffes,  and  thofe  of  the  larger 
joints,  it  is  no  uncommon  thing  for  the  patient  to 
remain  in  a  (late  of  perfect  health  till  the  abfcefs 
be  opened  either  by  art  or  nature,  and  the  air  gets 
admiffion.  But  in  a  few  days  after  this,  pain,  fore- 
nefs  and  tendernefs  of  the  neighbouringparts,  or  per- 
haps of  the  whole  body,  are  perceived  ;  a  fever  fu- 
perveneSjfometimes  preceded  by  cold  fhiverings,and 

fucceeded 


"  A  diarrhea  coming  on  at  the  beginning,  if  followed  by  a  flower  pulfe, 
prognofticatcs  fafety-  But  if  after  evacuations  by  ftool,  whether  procured  by 
nature  or  art,  the  pulfe  fhould  not  become  flower,  it  is  to  be  reckoned  as 

one  of  the  moft  dangerous  fymptoms." 

Ibid,  p.  31  andjpj. 


«c  They  are  commonly  taken  as  with  an  ague  fit  ;  there  is  a  ilrong  fhivcr- 
Ing  with  a  great  heat,  which  is  fuc:«ckd'by  a  pain  in  the  limbs  and  back, 

4Wl  a  violent  hurrying  pulfe," 

Hunter's  MS, 


APPENDIX.  265 

fucceeded  by  burning  and  fweating ;  at  other  times 
creeping  on  infenfibly,  but  always  accompanied 
with  an  immoderate  quick  pulfe  :  A  diarrhea  and 
pains  in  the  abdomen  frequently  follow  ;  and  the 
progrefs  of  the  difeafe  is  fo  rapid,  that  fometimes 
in  ten  or  twelve  days,  notwithftanding  the  ufe  of 
every  remedy,  death  clofes  the  fcene.  In  crowded 
hofpitals  thefe  fymptoms  occur  with  much  greater 
violence  than  in  private  pradice.  If  the  difeafed 
part  be  fo  fituated  as  to  be  removeable  by  amputa- 
tion, and  this  operation  be  performed  before  ab- 
forption has  taken  place,  or  has  proceeded  too  far, 
all  this  train  of  fymptoms  may  be  either  entirely 
o'bviated,  or  removed  by  it ;  and  I  have  feen  many 
cafes  in  which,  after  the  patient,  from  too  great 
delay,  had  been  brought  to  the  brink  of  the 
grave,  the  application  of  fponge  to  the  flump, 
according  to  the  method  defcribed  by  Dr.  Kirk- 
land,  has  occafioned  a  perfect  recovery  ;  the  quick- 
nefs  of  the  pulfe  being  immediately  abated,  and  all 
the  other  fymptoms  alleviated,  as  foon  as  the 
fponge,  by  imbibing  the  acrid  or  putrid  matter, 
had  prevented  its  abforption. 

Let  us  now  inquire  what  farther  circum dances 
there  are,  befrdes  that  of  the  quick  pulfe,  to  make 
it  probable  that  the  puerperaj^fever  is  occafioned 
by  abforption.  Notwithftanding  the  feveral  writ- 
ers whofe  attention  has  been  of  late  fo  much  ex- 
cited 


266  APPENDIX. 

cited  by  this  fever  have  differed  confiderably  con- 
cerning the  caufe  of  the  difeafe,  and  the  method  of 
cure,  they  have  certainly  obferved  its  appearances 
with  great  accuracy,  and  defcribed  them  with  equal 
minutenefs  and  fidelity.  Their  obfervations  may 
therefore  be  referred  to  as  fufficient  authority,  and 
the  following  are  of  much  weight  in  the  opinion  I 
mean  to  eftablifh. 

Dr.  Denman*  fays  "  (he  alfo  feels  great  pains 
*{  in  the  back,  hips  and  groins,  and  fometimes  in 
"  one  or  both  legs,  which  fwell,  appear  inflamed, 
*6  and  are  exquifitely  painful/'  A  little  farther  he 
fays,  "  In  fome  there  will  be  a  tranflation  of  the 
*f  difeafe  to  the  extremities,  where  the  part  affected 
<c  will  become  inflamed,  and  a  large  abfcefs  be 
"  formed."  In  another  place  he  fays,  "  Should 
"  abfceffes  be  formed  in  the  breads,  they  are  al- 
cc  ways  much  lamented,  but  there  is  great  reafon  to 
"  conclude,  that  they  prevent  more  grievous  and 
"  dangerous  complaints." 

Dr.  Leakefaysf  "  fome  of  thofe  who  furvived, 
"  recovered  very  flowly,  and  were  affected  with 
"  wandering  pains,  and  a  paralytic  numbnefs  of  the 
f(  limbs,  like  that  of  the  chronic  rheumatifm.  Some 
cc  had  critical  abfceffes  in  the  mufcular  parts  of  the 

"  body, 

*  Effay  on  the  Puerperal  Fever,  fecond  edit.  p>  9. 

I  Prafilicai  Obfervations  on  the  Childbed  Fever,  fecond  edit.  p.  59. 


APPENDIX.  267 

"  body,  which  were  a  long  time  in  coming  to  fup- 
"  puration,  and,  when  broke,  difcharged  a  fanious  ' 
"  ichor.0 

Again,  "  Thofe  who  were  feized  with  this  fever 
"  Were  not  fubjeft  to  abfceffes  of  the  breafts  ;  and 
"  of  thofe  who  happened  to  have  fuch  abfcefles, 
"  I  have  never  known  one  die  ;  neither  are  they 
"  fubjecl;  to  a  diarrhea,  or  much  fymptomatic  fe- 
"  ver,  although  the  pain  attending  a  fuppuration 
"  of  the  bread  is  often  very  acute." 

If  to  thofe  confiderations  we  add,  that  as  the  pu- 
erperal fever  is  more  fatal  in  large  cities  and  crowd- 
ed hofpitals  than  in  places  where  the  air  is  more 
open  and  pure,  fo  is  the  fever  occafioned  by  -ab- 
forption  of  matter — that  as  the  former  is  more  fa- 
tal in  fome  peculiar  conftitutions  of  the  air  than 
in  others,  fo  is  the  latter — that  as  the  puerperal  fe- 
ver does  not  appear  till  after  delivery,*  fo  neither 

does 

*  Till  fuch  a  change  is  produced,  women  are  not  "  fuh|eft  to  this  fever  ; 
<{  for  I  have  obferved,  that  thofe  with  child,  who  affifted  the  nurfes  in  at* 
"  tending  the  fick,  were  perfectly  free  from  it,  evea  when  it  wasmoft  rife; 
"  but  being  delivered,  feveral  of  them  fickened  foon  after,  and  were  affecled 
t;  with  the  fame  fymptoms  as  the  reft," 

Leake,  p.  88. 

Some  are  of  opinion  that  there  are  not  wanting  inftances  of  the  puerperal 
fever  being  formed  before  delivery  :  But,  ,.  May  not  thefc  fuggeftions  arife    \ 
from  fometimes  observing  cold  fhiverings  before  and  during  the  time  of  la- 
bour ?  And  if  a  puerperal  fever  come  on  foon  after  delivery,  ^  Might  they 

rot 


«8  APPENDIX 

does  abforption  of  matter  from  an  abfcefs  till  it  bd 
opened  and  the  air  have  accefs — we  may,  I  think, 
with  a  good  degree  of  certainty  conclude  that  the 
abforption  of  matter  is  the  immediate  caufe  of  the 
puerperal  fever,  as  well  as  of  that  confequent  up- 
&*  abfcefles  and  ulcers.  This  matter  is  either 
carried  off  by  fome  of  the  emuriclories,  as  by 
ftool,  which  is  the  moft  frequent,  by  a  frefh 
flow  of  the  lochia,  or  by  fweat  ;  or  elfe  it  is 
depofited  upon  fome  part  of  the  body.  If  in 
the  cavity  of  the  abdomen,  upon  the  lungs,*  the 

liver 

not  conclude  that  thofe  cold  fhiverings  were  fymptoms  of  that  fever  ?  But 
thefe  I  have  fo  frequently  fecn  without  the  puerperal  fever  fupervening,  or 
the  leaft  bad  confequcnce  enfuing,  that  I  am  certain  they  are  not  to  be  de- 
pended on.  Women  however  before  delivery  are  not  exempt  from  other 
fevers,  and  after  delivery  thofe  fevers  may  chang£  their  type  and  degenerate 
into  the  puerperal  ;  nay,  I  even  think  it  more  than  probable  that  if  there  be 
a  fever  of  any  kind  at  the  time  of  delivery,  it  may  occafion  an  abforption 
after  delivery,  and  fo  bring  on  one  of  the  puerperal  kind. 

^ns1-,"'11'111.  •t-~~'f~~' 

*  A  cough,  fhortnefs  of  breathing,  together  with  pleuritic  and  pei  ipneic« 
monic  fymptoms  frequently  occur  in  this  difeafe,  and  morbid  appearances 
in  the  cheft  have  been  found  upon  diffeftion. 

"  It  is  almoft  needlefs  t-o  remark  that  this  fever  muft  of  courfe.  be  com- 
**  plicated  with  any  diforder  that  the  patient  might  happen  to  labour  under 
"  at  the  time  of  childbirth.  The  chief  that  i  have  met  with  in  this  way  of 
*'  any  confequence,  hath  been  the  phthifis  pulmonalis*  If  any  difeafe  hath 
"  taken  its  immediate  origin,  as  it  were,  out  of  the  puerperal  fever,  and  been 
"  combined  with  it,  it  hath  been  the  peripneumony.  I  have  met  with  fev- 

"  eral  inftances  of  this  kind." 

Hulme,  p.  15. 

"  Both  lobes  of  the  lungs  were  inflamed,  and  fomewhat  black,   particu- 

<;  larly  in  their  moft  dependent  part." 

Ibid.  p.  41* 

('Adhcftons 


APPENDIX. 

liver,*  or  upon  any  of  the  vifcera,  it  generally 
proves  fatal  ;  if  upon  the  breafts,  the  limbs,  pr 
any  of  the  external  parts,  the  patient  always  re- 
covers. 

Let  us  next  inquire  what  is  the  fource  of  the 
matter  thus  abforbed.  That  the  increafed  bulk  of 
the  uterus  in  the  latter  months  of  pregnancy  mould, 
by  its  preffure  on  the  inteftines,  obftrucl;  the  free 
difcharge  of  the  excrements,  may  readily  be  con- 
ceived, and  is  known,  by  every  practitioner,  fre- 
quently to  happen.  Dr.  Denman  t  has  a  very 
jufl  obfervation  relative  to  this.  Speaking  of  the 
ftools  in  the  puerperal  fever,  he  fays,  "  they  are 
"  very  fetid,  of  a  green  or  dark  brown  colour,  and 
"^working  like  yeft,  and  it  is  remarkable,  that  af- 
"  ter  the  long  continuance  of  the  loofenefs,  when 
*'  the  patient  has  taken  little  nourifhment,  large 


L     J    ,0 

ii  {<  Adhefions  of  the  lungs  to  the  pleura  ;  a  collection  of  putrid  fe- 

"  lum  in  the  thorax,  and  matter  under  the  fternum,as  in  the  cafe  of  Harriet 
"  Trueman  -  on  inquiry  of  the  patient's  friends,  I  could  not  find  that  (he 
*•*  had  ever  been  in  the  leaft  fubjeft  to  any  complaint  in  the  breaft." 

Leake,  p.  93. 


*   <c  In  una,  quantum  comperi,  jecur  erat  mollis,  cnorrnis,  et  poftquam 
perfciflum  eft,  abcefTum  continerc  repertuwi." 

Diff.  Med*  Inaug.  d:  Febre  Puerper* 
Pat>\  Keary,  Edin.  1774,  p.  8. 

Dr.  Hulme,  p.  43,  fays,   "  The  liver  was  of  an  extraordinary  magnitude; 
irji  the  right  lobe  was  found  a  very  extcnfive  abfcefs*" 

f  Ibid,  p,  13. 


APPENDIX. 

"  and  hard  lumps  of  excrement  will  be  fometimes 
"  difcharged ;  which  one  might  fufpeft  to  have 
"  been  lying  in  the  bowels  a  long  time  before  de- 
"  livery/'  He  is  fo  particular  in  this  obfervation, 
that  he  repeats  it  in  another  place. 

The  horizontal  pofition  to  which  women  are  fo 
frequently  confined  after  delivery,  greatly  favours 
an  abforption  of  the  lochia.  As  this  matter  feems 
but  imperfectly  underftood,  no  proper  diftin&ion 
having  been  made  between  the  abforption  and  ob- 
JiruBwn  of  the  lochia,  I  mall  beg  the  reader's  pa- 
tience while  I  attempt  to  give  my  ideas  of  it  fome- 
what  at  large. 

Writers  agree  that  the  puerperal  fever  attacks 
indifferently  perfons  who  have  had  a  fmall,  or  a 
large  difcharge  of  the  lochia.  This  is  a  well  founds 
ed  fa 9;  ;  but  from  hence  they  have  concluded  that 
the  lochia  can  have  no  mare  in  producing  the  dif- 
eafe — a  conclufion  to  which  I  cannot  affent.  In 
other  cafes  it  is  conftantly  found  that  matter  will 
be  abforbed,  whether  the  difcharge  be  fmall  or 
great  ;  and,  what  may  feem  extraordinary,  it  is 
frequently  feen  that  where  the  difcharge  is  in  the 
largeft  quantity,  the  abforption  is  moil  confidera- 
ble.  But  abforption  may  in  all  cafes  be  increafed, 
and  in  fome  entirely  caufed,  by  fuch  an  unfavour- 
able pofition  as  may  occafion  the  matter  to  lodge 

in 


APPENDIX. 

in  a  wound,  where,  growing  acrid,  it  will  produce 
inflammation  and  fever  by  its  irritation.  By  the 
application  of  fponge,  an  incifion  in  the  moft  de- 
pending part,  or  mere  alteration  of  pofition,  thefe 
fymptoms  frequently  foon  difappear  ;  the  matter 
becomes  more  laudable,  and  is  even  diminiihed  in 
quantity.  We  mall  prefently  fee  how  thefe  obfer- 
vations  apply  in  the  puerperal  fever. 

That  accurate  anatomift,  Dr.  Hunter,  has  dif- 
covered  the  falfe  or  fpongy  chorion,  called  by  him 
the  caduca,  or  membrana  decidua,  to  be  a  lamella  or 
efflorefcence  of  the  womb,  which  peels  off  from  it 
like  a  flough  at  each  fucceffive  birth.  It  is  an 
opaque  membrane,  thicker  than  the  true  chorion, 
and  exceedingly  tender  in  its  texture,  being  hard- 
ly firmer  than  curd  of  milk  or  coagulated  blood. 
It  is  however  vafcular,  having  veflfels  which  carry 
red  blood  from  the  uterus.  It  is  not  to  be  inject- 
ed by  inje&ing  the  placenta,  being  not  a  fetal,  but 
an  uterine  part.  After  delivery,  the  greatefl  part 
of  this  membrane  is  left  behind,  grows  putrid, 
gradually  diffolves,  and  comes  away  in  a  fluid 
ft  ate  along  with  the  clean  (ings.  It  frequently  how- 
ever, is  fo  long  in  feparating,  that  on  diffe&ion* 
of  feveral  who  have  died  of  the  puerperal  fever, 
the  infide  of  the  uterus  has  been  found  lined  with 
it ;  and  it  has  been  of  fo  black  a  colour,  that  the 

womb 

*  See  leake,  p.  75,  and  1 79. 


*7*  APPENDIX. 

4J  •  3 

womb  itfelf  has  been  fuppofed  to  be  mortified,  till 
the  miftake  was  difcovered  by  wiping  off  this  fub- 
ftance.  Thus  we  have  a  matter  entirely  fitted  for 
abforption  ;  and  as  the  communication  between 
the  mother  and  child  is  carried  on  not  by  continu- 
ity of  veffels  between  the  placenta  and  uterus,  but 
a  reciprocal  abforption  of  blood  by  means  of  pat- 
ulous  orifices,  we  may  conclude  that  the  womb 
is  an  organ  of  all  others  the  moft  favourably  form- 
ed to  abforb. 

That  patients  in  this  fever  fhould  generally 
complain  of  pain  and  forenefs  at  the  lower  part  of 
the  belly  ;  and  that  the  omentum,  peritoneum  and 
inteftines  mould,  frequently,  be  firfl  and  princi- 
pally affefted,  and  on  diffe&ion  be  found  inflamed, 
fuppurated  or  gangrened,  might  naturally  be  ex- 
pected from  their  contiguity  to  the  fource  of  the 
abforbed  matter.  Thefe  are  the  common  confe- 
quences  of  the  depofition  of  acrid  matter  upon  a 
tender  part.  But  the  inflammation  excited  in  this 
manner  in  a  relaxed  habit,  and  happening  fre- 
quently after  a  confiderable  lofs  of  blood,  is  very 
different  from  one  occafioned  by  obftra&ed  per- 
fpiration,  in  a  plethoric  habit,  where  no  confider- 
able evacuation  has  preceded.  Dr.  Leake  relates 
the  cafe  of  Sarah  Evans,  p.  224,  who  was  of  a  very 
delicate  irritable  habit  and  lax  fibres  ;  fhe  was 
feized  with  this  fever  on  the  third  day  after  deliv- 
ery, 


APPENDIX. 

eiy,  when  her  fldh  was  moift  and  her  pulfe  quick 
and  weak  ;  fhe  died  on  the  12th  day.  On  open- 
ing the  body,  evident  marks  of  inflammation  ap~ 
peared,  particularly  in  the  abdomen  ;  a  great  part 
of  tlie  omentum  was  deftroyed  and  converted  into 
matter,  and  what  remained  was  become  gangrenous, 
&c.  —  The  Doftor  makes  the  following  remark. 
'"  Where  the  pulfe  was  extremely  foft  and  weak 
"  and  the  circulation  languid,  it  is  difficult  to  ao 
"  count  for  fo  fudden  and  high  a  degree  of  inflam- 
"  mation  as  to  produce  a  colle&ion  of  matter,  6r 
"  any  inflammatory  affection  of  the  abdominal 
"  vifcera  ;  but  fo  it  was." 

In  another  place,  he  fays,  "  Confidering  the 
"•  languid  ftate  of  the  patient,  and  the  weaknefs  of 
"  the  pulfe,  even  in  the  beginning  of  this  fever,  I 
"  was  furprifed  to  find  that  the  inflammation  had 
"  fometimes  run  fo  high,  and  made  fo  rapid  a 
"  progrefs,  as  to  produce  matter  in  the  abdomert 
"•  fo  early  as  the  fourth  or  fifth  day  after  the  firfl 
"  attack  ;  as  will  appear  in  the  cafe  of  Harriet 
"  Trueman."* 

He  alfo  obferves,t  "  that  in  the  winter  months, 
"  when  the  childbed  fever  began,  the  weather  was 
<c  obferved  to  be  remarkably  mild  and  moift, 
*j  with  a  warmer  temperature  of  the  air  than  wa$' 

*s  natural 


*  Leake,  p.  io6,        f  ftia,  p.  37, 

s 


AT.P  P  END  IX. 
"  natural  to  the  feafon."     But  it  is  well  known 
that  true  inflammatory   diforders  prevail  moft  in 
cold  dry  eafterly  winds. 


In  regard  to  the  prevention  and  cure  of  this  fe- 
ver, there  is  not,  I  believe,  a  man  of  eminence  in 
the  profeffion  who  is  not  thoroughly  convinced  of 
the  neceflity  of  pure,  free,  and  even  cool  air  ; 
though  perhaps  their  directions  on  this  head  are 
feldom  fo  ilriftly  put  in  execution  as  might  be 
wifhed.  But  there  is  another  point  of  practice 
which  is  by  no  means  hitherto  fettled  ;  this  is  the 
pofition  of  the  patient  for  fome  time  after  deliv- 
ery. Several  of  the  firft  accoucheurs  and  princi- 
pal nurfes  in  London  keep  their  patients  in  bed 
for  five  or  fix  days,  or  more,  without  ever  permit- 
ing  them  to  get  out  of  it,  and  what  perhaps  is  worfe, 
without  fufferirig  them  to  fit  up  in  bed,  or  even  raife 
their  heads  from  the  pillow.  And  one  gentleman, 
defervedly  of  'high  character  in  the  profeffion,  in 
a  late  publication  has  declared,  "  that  in  his  own 
practice  he  has  feen  more  frequent  inftances  of  the 
puerperal  fever  from  early  fitting  up  than  from 
all  other  accidental  caufes  united/'  Were  this, 
however,  the  real  caufe  of  puerperal  fevers,  it  would 
be  aftonifhmg  that  any  of  my  patients  fhould  ef- 
cape  them,  as  I  conftantly  direct  them  to  fit  up  in 
an  hour  or  two  after  delivery,  and  to  repeat  it  as 
frequently  as  poffible,  and  even  to  get  out  of  bed 

in 


A  P  P  E  N  D  I  X.  275 

in  lefs  than  twenty  four  hours  ;  and  it  is  feldom 
that  they  exceed  this  period.  One  lady,  indeed, 
whom  I  attended  in  two  lyings  in,  lay  in  bed  five 
days  each  time,  and  in  one  of  them  was  for  the 
moft  part  confined  to  a  horizontal  pofture  ;  and 
in  that  fhe  had  a  puerperal  fever  ;  whereas  this  dif- 
eafe  has  very  rarely  occurred  among  others  whom 
I  have  delivered,  and  has  never  once  proved  fatal* 
Perhaps  in  London  it  may  be  thought  early  to  fit 
up  in  one  day  after  delivery,  or  to  get  out  of  bed 
in  two  or  three.  Now  if  a  horizontal  pofition  has 
been  conftantly  maintained  for  that  time,  and  the 
feeds  of  the  puerperal  fever  have  been  thereby 
fown,  the  fudden  change  of  pofture  and  of  cloth- 
ing may  perhaps  make  it  fhew  itfelf  fomewhat 
fooner  than  it  would  otherwife  have  done ;  and 
this  I  think  I  have  feen. 

I  have  taken  fome  pains  to  inquire  both  of  the 
gentlemen  of  the  faculty,  and  the  moft  intelligent 
nurfes,  whether  they  had  other  reafons  befides  that 
already  mentioned  for  keeping  their  patients  fo 
long  in  a  horizontal  pofture  ;  and  as  far  as  I  can 
learn,  early  fitting  up  occafioned,  as  they  imagin- 
ed, a  prplapfus  of  the  vagina,  or  bearing  down,  as 
it  is  commonly  termed.  But  I  have  already  de- 
clared my  opinion  that  this  complaint  is  generally 
owing  to  a  quite  different  caufe,  the  forcible  ex- 
tra&ion  of  the  fhoulders  of  the  child  ;  and  I  can 
S  2  affirm 


276  APPENDIX. 

affirm  in  the  moil  pofitive  manner,  that  early  fit- 
ting up  has  never  produced  it  in  the  flighted:  de- 
gree, in  thofe  whom  I  have  delivered. 

That  a  horizontal  pofition  mould  promote  that 
abforption  of  matter  which  I  confider  as  in  great 
meafure  the  caufe  of  puerperal  fev.exs,  will  appear 
probable  from  various  confideratioms.  The  weight 
of  the  uterus  in  this  pofture  carries  it  clofe  to  the 
vertebras,  and  caufes  its  fides  to  approach  each  oth- 
er, fo  as  to  render  its  figure  flatter  ;  by  which  means 
its  contra&ion  muft  be  impeded,  and  confequently 
the  expulfion  of  its  contents  retarded.  The  dif- 
charge  of  the  lochia,  too,  is  not,  in  this  cafe,  affift- 
ed  by  gravitation  ;  hence  they  will  be  apt  to  lodge 
and  ftagnate  in  the  tranfverfe  rugae  of  the  vagina. 
Whereas  an  upright  pofition  produces  effeds  the 
contrary  to  thefe.  The  uterus  preffing  forwards 
upon  the  loft  parities  of  the  abdomen,  will  meet 
with  no  obftacle  to  its  contraction  ;  and  the  lochial 
discharges,  finding  a  ready  exit  by  a  depending  ori- 
fice, will  drain  off  as  foon  as  they  have  acquired 
fufiicient  fluidity. 

An  obfervation  from  natural  hiftory  may  be  ad- 
duced in  confirmation  of  this  idea  of  the  different; 
effects  of  an  upright  and  a  horizontal  pofture.  No 
Quadrupeds  are  found  to  menflruate,  except  fo  me 
of  the  monkey  tribe  ;  and  of  thefe,  according  to* 

that 


A  P  P  E  N  D  I  X. 

that  eminent  naturalift  Mr.  Buffon,*  only  fuch  as 
either  habitually  or  Occafionally  ufe  an  creel:  pof- 
ture  in  fitting  or  walking,  are  fubjed  to  this  peri- 
odical ^difcharge. 

By  the  mode  of  pra&ice  which  it  has  been  the 
purpofe  of  the  foregoing  treatifc  to  inculcate,  I 
have  hitherto  been  able  either  to  prevent,  or  if  call- 
ed in  time,  to  cure  the  puerperal  fever  ;  but  when 
it  exifts  in  that  malignant  endemic  form  in  which 
it  fometimes  appears  in  a  lying  in  hofpital,  I  fear 
no  method,  as  yet  propofed,  will  be  fufficient  to 
Hop  its  ravages.  Under  thefe  deplorable  circum- 
ilances,  one  remedy,  which  has  not,  I  believe,  been 
mentioned  by  any  writer  on  the  fubject,  might  be  tri- 
ed without  the  imputation  of  ralhnefs.  This  is  a  bath 
of  fuch  a  degree  of  temperature  as  only  to  give  a  gen- 
tle mock.  Watfm  bathing  has  been  ufed  without  fuc- 
cefs.  Dr.  Leaket  fays,  "  One  would  have  imagined 
5;  that  the  warm  bath  bid  fairer  to  anfwer  this  inten- 
"  tion  than  any  thing  elfe,  as  it  a6ls  like  an  uni- 
ft  verfal  fomentation  applied  to  the  furface  of  the 

"  body  ; 

*  <c  Le   Gibbon,  Le  Magot,  &c.  Les  femcllcs  font,  comme  les  Femme*, 
Tujcttes  a  une  ecoulement  periodiquc  de  fang."     Tom.  14. 

11  Le  Coaita,  L'exquimc,  &c.  Les  femelles  ne  font  pas  fujettes  a  1'ecoule- 
:nent  periodique."  Tom.  15. 
;**  Simla  — — -  Femina  menftruat." 

linneei  Syfl,  Mt,  Vol.  I.  p.ttf* 

83 

,t  Ib,  p.  117. 


278  A  P  P  E  N  D  I  X; 

4t  body  ;  and  the  rather,  fince  it  has  been  found  to 
"  procure  almoft  inilant  eafe  in  other  diforders  of 
"  the  bowels  ;  but  to  the  confufion  of  all  theory, 
"  in  thofe  cafes  where  it  was  tried,  it  by  no  means 
"  anfwered  my  expectation  ;  and  from  what  I 
<c  could  learn,  fucceeded  no  better  with  others  ; 
"  for  the  greatefl  part  of  thofe  died  for  whom  it 
"  was  directed."  That  a  temperate  bath  might 
prove  efficacious  in  preventing  the  difeafes  to 
which  lying  in  women,  from  too  delicate  treat- 
ment, are  liable,  we  have  fome  reafon  to  conclude, 
from  the  practice  which,  both  in  ancient  and  mod- 
ern times,  has  prevailed  in  many  parts  of  the 
world,  of  bathing  immediately  after,  and  in  fome 
before  delivery,  in  water  of  the  common  tempera- 
ture. Some  examples,  which  might  eafily  have 
been  multiplied,  of  the  prevalence  of  this  cuftom, 
are  inferte'd  in  the  notes.*  Whether,  while  the 

puerperal 

*  With  rcfpeft  to  ancient  teftimonies  of  this  practice,  we  hare  the  fol. 
lowing  paffage  in  the  Andrian  of  Terence,  A&.  III.  Sc.  2, 

,  L     E     S    B     I     A. 

Adhuc  Archillis  qua:  adfolent,  quaeque  oportet 
Signa  ad  falutem  efle,  omnia  huic  effe  video. 
Nunc  primum  fac,  ifthaec  ut  lavet  ;  poft  deinde, 
^uod  jufli  ei  ante  bibera,  &  quantum  imperavi, 
Date  :  MOJC  ego  hue  revertor. 

Madame  Dacier's  remark  upon  thefc  lines  is  much  to  our  purpofe.  3.  Nunc 
primum  fac,  ijlkecc  ut  lavet.  La  premier  chofe  que  VMS  devezfaire  c'ejl  de  /a  baig- 
iter,  C'ctoit  la  coutume  en  Grece,  des  qu'une  femme  etoit  accoudiee  on  la 
mettoit  au  bain.  II  y  a  .fur  cela  un  paffage  rexnaiquabk  dans  Callimaqtie^  & 
Tin  autre  ^ans  Lutisn* 


A  P  P  E  N  D  I  X. 

puerperal  fever  is  a6tually  prefent,  this  practice 
might  with  fafety  or  probability  of  fuccefs  be  em- 
ployed, I  fhall  not  venture  to  determine.  In  an 

obftinate 

The  paflage  in  Callimachus  here  referred  to  proves  that  women  bathed-ifi 
4  running  Jlream  immediately  after  delivery. 


foov      aTO?,   a  as 
HOV  <f  ail 


Hie  te  poftquam  mater  magno  depofuit  ex  utero, 
Statim  quaerebat  Ttvum  aquae,  qiiopartus^e 
Sordes  ablueret,  tuumque  corpus  purgaret. 

Some  of  the  moft  particular  and  beft  attefted  modern  accoxmts  of  this  cnf- 
tom,  are  the  following  : 

*'  The  Americans  that  inhabit  the  Ifthmus  of  Darien,  make  no  difficulty 
of  plunging  into  cold  water  wh£n  triey  are  m  a  fweat,  to  cool  themfelves  j 
Kkewife  the  mothers  with  their  children  bathe  in  cold  water  immediately 
after  they  are  brought  to  bed.  This  is  certain,  that  they  never  receive  any 
damage  from  this  cuftom  ;  whereas,  on  the  contrary,  many  women  fuffer 
greatly  in  thefe  parts  from  too  delicate  a  regimen." 

Brookes's  Nat.  Hift.  Vol.  I.  p.  175. 

The  following  quotation  is  taken  from  Wafer's  new  Voyage  and  Defcrip- 
tion  of  the  Ifthmus  of  America,  price  as.  printed  in  1  704,  now  added  to 

Pampier's  Voyage,  Vol.  "Ill,  p.  360, 

•    ' 

rrP!  v.»  ",'--?jiitt& 

v«a*'r  When  a  woman  is  delivered  of  a  child,  another  woman  takes  it  in  her 
arms  within  half  an  hour  or  lefs  .after  it  is  born,  and  takes  the  lying  in  wom- 
an upon  Jier  back,  and  goes  with  both  of  them  into  the  river  and  walhes 
them  there," 

Wafer,  p.  360.     . 

"  The    ; 


*8o  APPEND!  X, 

obftinate  conflipation  of  the  bowels,  attended  with 
extreme  pain,  confiderable  fever,  and  immediate 
danger,  Dr.  Stevenfon  informs  us  that  a  cure  was 

obtained 

"  The  Brazilian  women  are  extremely  fruitful,  have  very  eafy  labours, 
and  rarely  mifcarry,  for  no  fooner  is  a  women  delivered,  but  up  fhe  gets  to 
the  next  river,  and  without  any  further  help  wafhes  herfelf  there." 

Newhoff's  Voyages,  p.  151. 

**  The  Tapoyar  women  cut  the  navel  Sring  with  a  fhcll,  and  wafti  thcm- 
felves  and  their  children  every  morning  and  evening  after  delivery." 

Ib,  p.  154. 

The  Brazilian  women  are  very  fruitful,  have  eafy  labours,  retire  to  the 
woods,  where  they  bring  forth  alone,  and  return  after  warning  themfelves 
and  their  child  ;  the  hufbands  lying  in  bed  the  firft  twenty  four  hours,  and 
being  treated  as  if  they  had  endured  the  paius.  Confirmed  by  Woods  Rog- 
ers, p.  57. 

**  The  CalifoTnians  had  adopted  that  abfurdity,  which  is  fo  much  laughed 
at  in  the  accounts  of  Brazil,  that  the  women  after  delivery,  ufed  imme- 
diately to  goto  fome  water  and  wafhthemfelvcs  and  the  child ;  and  in  other- 
particulars  to  obferve  no  manner  of  caution,  going  to  the  foreft  for  wqod. 
and  food,  and  performing  every  other  fecvicc  the  hufband  wanted." 

Nat.  and  civil  HiJI.  of  California,  tranjlatedfrom.  the  original  Spani/h  «f  Miguel 
Vtntgas^  a  Mexican  Jefuit  ;  publijhcd  in  1758,  translated  1759.  p.  81  and 
82.  N.  B.  The  northern  point  of  California  is  in  lat.  46, 

.  Long,  Efq;  one  of  the  judges  of  the  admiralty,  in  his  Hiftory  of 
Jamaica,  publiftied  in  1774,  Vol.  II.  Book  III,  Chap.  i.  p.  380,  fpeaking 
of  the  negroes  on  that  part  of  the  African  continent  called  Guinea,  or  Ne- 
gro Land,  fays,  "  Their  women  are  delivered  with  little  or  no  labour  ;  they 
Have  therefore  no  more  occafion  for  mid  wives  than  the  female  Oranoutang,  or 
any  other  wild  animal.  A  woman  brings  forth  her  child  in  a  quarter  of  an 
Jiour,  and  goes  the  fame  day  to  the  fea  and  waflies  herfelf,  Some  have 
been  known  to  bring  forth  twins  without  a  fhriek  or  a  fcream,  and  it  is 
Celdoai  they  are,  confined  above  two,  W  at  .raoft  three  days.  Immediately 

before 


APPENDIX. 

obtained  chiefly  by  daftiing  cold  water  upon  tb« 
lower  extremities  up  as  high  as  the  pubes,  and 
plunging  the  feet  into  cold  water,  after  the  warm 
bath  had  failed.  Edin.  Med.  Ef.  vol.  VI.  393. 
What  analogy  this  cafe  may  have  to  the  puerperal 
fever,  I  leave  my  readers  to  judge. 


Since  the  publication  of  the  former  edition  of 
my  treatife,  I  have  received  a  letter  from  that  ex- 
cellent profeffbr  of  midwifery,  Dr.  Young  of  Ed- 
inburgh, containing  an  account,  well  worthy 
the  attention  of  the  faculty,  of  the  appearance 
of  the  puerperal  fever  in  the  lying  in  ward  of 
the  infirmary  of  that  city.  The  letter  is  dated 
November  21,  1774,  and  the  following  is  an  ex- 
tract from  it  : 

"  We  had  the  puerperal  fever  in  the  infirmary 
cs  laft  winter.  It  began  about  the  end  of  Febru- 
ft  ary,  when  alrnoll  every  woman,  a£  foon  as  fhe 
'*  was  delivered,  or  perhaps  about  twenty  four 
"  hours  after,  was  feized  with  it ;  and  all  of  them 
5*  died,  though  every  method  was  tried  to  cure  the 

"  diforder. 

tefore  her  labour  fhe  is  conduced  to  the  fea  fide,  or  a  river,  followed  bv  -^ 
number  of  little  children,  who  throw  all  manner  of  ordure  or  excrement  at 
her  in  the  way,  after  which  fjpie  is  warned  with  great  care.  Without  this 
cleanly  ceremony,  the  negroes  are  perfuaded  that  either  the  mother,  the 
J,  or  one  of  the  parents,  will  die  during  the  period  of  lying  in." 


APPENDIX. 

JH| 

"  diforder.  What  was  fingular,  the  women  were 
<c  in  good  health  before  they  were  brought  to  bed, 
"  though  fome  of  them  had  been  long  in  the  hof- 
te  pital  before  delivery.  One  woman  had  been  dif- 
"  miffed  the  ward  before  me  was  brought  to  bed  ; 
"  came  into  it  fome  days  after  with  her  labour 
"  upon  her;  was  eafily  delivered,  and  remained 
'•'  perfe&ly  well  for  twenty  four  hours,  when  me 
"  was  feized  with. a  fhivering  and  the  other  fymp- 
ec  toms  of  the  fever.  I  caufed  her  to  be  removed  to 
"  another  ward  ;  yet,  notwithftanding  all  the  care 
"  that  was  taken  of  her,  me  died  in  the  fame  man- 
"  ner  as  the  others.  I  muft  inform  you  at  the 
f*  fame  time,  that  the  difeafe  did  not  exifl  in  the 
<:  town.  To  account  for  this  <Jiftemper  in  the  ly- 
"  ing  in  ward,  I  muft  acquaint  you  that  it  has 
"  been  a  general  obfervation,  that  the  patients  in 

"  the  infirmary  who  had  undergone  any  confider- 

4C  able  operations,  were  more  fubjeft  to  eryfipelat- 
"  ous  fwellings '  than  formerly.  I  found  that  the 
£C  women  in  the  lying  in  ward  laft  year  did  not 
"  recover  fo  well  as  formerly,  but  fcarcely  any  of 
"  them  died.  It  was  thefe  appearances  which 
<£  made  me  think  there  was  a  local  infection,  and 
"  determined  me  to  ihut  up  the  ward  till  it  could 
"  be  removed.  This  I  did,  after  lofing  fix  wom- 
"  en.  I  then  wafhed  and  painted  the  ward,  caufed 
"  all  thebedding  to  be  removed,  and  fired  gunpow- 
c;  derat  different  times  in  the  ward,  I  had  a  number 

"  of 


APPENDIX.  283 

"  of  chaffers  filled  with  cinders,  which  burnt  all 
*f  night  ;  and  all  the  windows  were  opened  through 
"  the  day.  This  operation  lafted  about  a  fort- 
"  night,  when  I  furnifhed  the  ward  with  new  bed-' 
"  ding,  put  no  curtains  to  the  beds,  and  by  this 
"  put  an  entire  ftop  to  the  difeafe.  The  ward  was 
"  open  to  receive  patients  in  a  fortnight  from  the 
cc  time  it  was  firft  fhut  up.  The  bodies  of  all  the 
"  women  were  opened,  and  we  found  exaftly  the 
"  fame  appearances  as 'are  mentioned  by  thofe  who 
"  have  wrote  upon  that  diforder.  Though  the 
"  omentum  was  often  found  fuppurated,  yet  in 
(t  none  of  them  was  there  any  appearance  of  a 
*'  gangrene." 

Several  fac~ls  of  importance  in  the  hiftory  of  the 
puerperal  fever  are  contained  in  this  account  ;  par- 
ticularly— that  none  of  the  women  were  feized  with 
it  before  delivery,  though  fome  of  them  had  been 
long  in  the  houfe — that  although  the  difeafe  was 
fo  fatal  in  the  infirmary,  it  did  not  exift  in  the 
town — and  that  an  entire  flop  was  put  to  it  by 
thoroughly  cleanfing  and  new  furnifhing  the  ward, 
fo  that  in  a  fortnight  after  it  was  opened  again  with 
fafety  for  the  reception  of  patients. 

Poflibly  it  may  be  urged  as  an  argument  againft 
abforption,  that  "  almoft  every  woman  as  foon  as 
^  fhe  was  delivered,  or  perhaps  about  twenty  fcr 

"  hou 


A  P  P  E  H  D  I  X. 

46  hours  after,  was  feized  with  this  fever."  But  I 
believe  this  obje&ion  will  not  be  found  of  any 
force,  if  we  confider  that  it  will  not  be  an  eafy  mat- 
ter to  determine  whether  the  heat,  fhiverings,  or  ac- 
celerated pulfe,  which  happen  in  fome  hours  after 
delivery,  are  the  fymptoms  of  a  puerperal  fever, 
or  merely  the  effe&s  of  the  labour  ;  efpecially  in 
an  irritable  habit  of  body,  as  thefe  are  fymptoms 
which  are  frequently  feen  foon  after  delivery  when 
no  fever  has  fupervened  ;  and  an  abforption  may 
take  place  in  a  very  few  hours. 


it       '..:<• 

Mr.  Eli  Cope,  afuingenious  furgeon  of  Leek  in 
Stafford  (hi  re,  who  formerly  lived  in  my  houfe  a 
con fiderable  time  as  a  pupil,  and  whofe  veracity 
may  be  depended  on,  has  ^Savoured  me  with  a 
remarkable  confirmation,  from  his  own  pra£Hce,  of 
the  fafety  and  advantage  df  the  method  of  treat- 
ment which  I  have  inculcj^ed.  From  an  exacl;  ac- 
count of  every  woman  Re  has  delivered  fince  he 
left  me,  amounting  to  593,  with  the  circumftances 
of  their  cafes,  he  allures  me  that  he  has  not  loft  one 
from  the  puerperal  fever,  nor  from  any  other  caufe 
where  he  alone  was  concerned.  Many  preternat- 
ural, laborious,  and  flooding  cafes  had  occurred  a- 
mong  this  nupber  ;  yet  they  were  all  managed  ac- 
cording to  the  plan  abov e  recommended ;  and  par- 
ticularly not  a  fingle  patient  had  lain  in  bed  twen- 

ty 


APPENDIX. 

ty  four  hours  together  after  delivery,  One  in- 
ftance  that  he  relates  of  the  good  effeds  of  fuffer* 
ing  their  fhoulders  to  make  their  proper  turns,  in 
preventing  afterpains,  is  fo  remarkable  that  I  fiiall 
give  it  at  length  in  his  own  words. 

"  A  Farmer's  wife  in  our  neighbourhood  appli- 
"  ed  to  me  in  February  1773,  defiring  me  to  at- 
"  tend  her  in  her  labour,  which  fhe  expecled  in  a 
"  few  weeks.  She  told  me  me  had  had  fix  chil- 
"  dren,  and  had  very  eaty  labours  ;  but  that  fhe 
*'  had  fuffered  fo  much  with  afterpains  for  a  fort- 
<;  night,  that  it  rendered  her  unable  to  leave  her 
"  room  at  the  end  of  fix  weeks.  I  attended  her  in 
"  a  natural  good  labpur..  As  foon  as  the  head  of 
"  the  child  was  born,  I  obferved  the  moulders  to 
c<  make  their  turn,  having  my  left  hand  under  the 
"  child's  chin,  and  the  right  hand  on  the  occiput. 
"  In  this  pofition  I  was  determined  to  wait  till  a 
"  pain  came,  which  was  feventeen  minutes  :  This 
**  forced  the  child  as  far  as  the  hips.  The  next  pain, 
<e  which  was  in  about  two  minutes,  totally  expell- 
"  ed  the  child. 

"  1  have  fince  attended  her,  and  only  waited 
"  fourteen  minutes  after  the  head  was  born.  She 
"  never  after  had  a  fmgle  afterpain,  but  was  about 
"  her  bufmefs  in  three  weeks/1 


My 


A  P  P  E  N  D  I  X. 

My  worthy  friend  Dr.  Aikin,  whofe  chara&er 
and  abilities  are  well  known  to  the  public,  and 
others  of  my  pupils,  as  well  as  many  other  pra&i- 
tioners,  have  alfo  favoured  me  with  their  teftimo- 
ny  to  the  fuccefs  of  the  feveral  points  of  practice 
recommended  in  the  foregoing  treatife. 


ADDITIONAL 


APPENDIX.  387 


ADDITIONAL 
A  S  E  S. 


CASE       XVI. 

JONATHAN  KERSH  A Ws  wife  of  Hav- 
en near  Greenacre  Moor,  in  the  parifh  of  Oldham, 
about  thirty  years  of  age,  being  at  the  full  period 
of  geilation,  had  the  misfortune  on  the  fecond  of, 
July  1770,  to  fall  upon  a  pot  veflel,  which  broke, 
cut  through  her  clothes,  and  made  an  horizontal 
wound  in  the  abdomen,  about  a  quarter  of  an  inch 
above  the  navel,  and  about  two  inches  in  length. 
Labour  pains  immediately  fucceeded,  and  ftie  was 
delivered  in  about  thirteen  hours  of  a  living  child. 
I  faw  her  in  about  fifty  hours  after  the  accident, 
and  found  that  a  piece  of  the  omentum,  as  large 
as  my  fift,  had  protruded  itfelf  through  the  wound, 
and  lay  upon  the  outude  of  the  abdomen ;  it  had  a 

very 


*88  A  P  P  E  N  D  I  X. 

very  putrid  appearance,  difcharged  a  bloody  ferum, 
and  fmelt  very  ofFeniively.  The  omentum  was 
wounded,  and  a  triangular  piece  of  pot  was  found 
within  it.  I  fpread  it  open  carefully,  to  examine 
whether  any  portion  of  the  inteflines  was  protruded 
along  with  it,  and  being  fatisfied  that  there  was  not,  I 
applied  a  ligature  round  it  clofe  to  the  abdomen,  and 
then  cut  off  all  that  part  beyond  the  ligature.  In 
about  a  fortnight  the  ligature  came  away,  and  in 
lefs  than  a  month  the  wound  was  perfectly  healed 
without  the  leaft  inconvenience,  and  me  has  fince 
had  another  living  child. 

R     E     MARK. 

Tkis  cafe,  as  far  as  one  inftance  will  go,  proves 
that  the  omentum  in  puerperal  women  is  not  par- 
ticularly liable  to  inflammation,  fuppuration,  and 
mortification  ;  but  in  thofe  cafes  where  there  has 
been  that  appearance  upon  difle&ion,  it  has  been 
owing  to  acrid  matter  being  abforbed  and  depofit- 
ed  upon  it,  and  not  to  any  original  difeafe  in  the 
part  produced  by  pregnancy  or  parturition. 

CASE       XVII* 

IN  the  poftfcript  to  rny  account  of  the 
puerperal  fever,  I  think  I  have  fufficiently  refuted 

the 


APPENDIX.  i89 

the  do6lrine  of  thofe  phyficians  who  have  imagin- 
ed that  the  diforder  is  equally  common  in  all 
places.  The  following  cafe  will,  I  believe,  be  a 
fufficient  anfwer  to  thofe  who  have  maintained  the 
oppofite  opinion,  alleging  that  it  is  only  generat- 
ed in  the  metropolis,  and  never  exifts  in  other  parts 
of  the  kingdom.  We  fhall  here  fee  it,  in  a  very 
malignant  (late,  make  its  appearance  in  the  town ' 
of  Manchefter. 

A.  B.  of  Manchefter,  a  remarkably  heal  hy 
woman,  who  had  hitherto  fcarcely  experienced  a- 
ny  diforder,  was  in  the  beginning  of  her  firft  preg- 
nancy afflicted  with  pains  in  her  ftomach,  attend- 
ed with  vomitings  ;  but  during  the  laft  four 
months  me  was  perfectly  well,  at  leaft  as  free  from 
complaints  as  one  can  be  fuppofed  to  be  in  her  lit- 
uation. 

On  the  27th  of  October,  1772,  me  was  deliver- 
ed of  two  children  by  a  careful  furgeon  in  this 
town,  who  conduced  the  labour  with  great  pro- 
priety. Her  labour  which  continued  about  fifteen 
hours,  was  rather  flow  than  difficult.  The  firft  born 
child  prefented  itfelf  in  a  natural  pofition  ;  the  fec- 
ond  with  the  buttocks  foremoft  ;  but,  as  the  infant 
was  very  fmall,  it  was  eafily  brought  into  the  world 
in  that  pofture.  The  placenta  was  expelled  na- 
turally. For  a  day  or  .two,  the  patient  imagined  v 
T  ihe 


290  APPENDIX. 

Ihe  perceived  a  large  lump   which  feemed  to  roll 
about  within  her  belly,  and   which   fhe  fometimes 
endeavoured  to  fix  by  holding  her    hand  upon  it. 
This,  however,  gave  her  no  pain  ;  and  after  the  fec- 
ond    day,    this    fymptom,  which  arofe  from   the 
womb's    not  having  fufficiently    contracted    itfelf, 
entirely  vaniihed.     The   lochia.  flowed  plentifully, 
her  milk  was  fecerned  in  proper  quantity,  and  the 
gave  fuck  to  her  children. 

On  the  third  day,  me  complained  of  a  little  pain 
in  her  belly  ;  and  as  me  had  not  had  a  flool  fince 
her  delivery,  a  clyfler  and  fome  opening  medicines 
were  adminiflered,  which  procured  a  plentiful  e- 
vacuation  ;  and  in  the  evening  fhe  took  an  opiate. 

On  the  fourth  day  (he  was  pretty  eafy. 

On  the  fifth  me  complained  of  pain  and  fore- 
nefs  in  the  lower  part  of  the  abdomen,  which  grew 
fo  troublefome,  that  it  was  thought  necefTary  to  re- 
peat the  opiate  ;  and  fome  fmall  dofes  of  emetic 
tartar  were  adminiflered,  which  puked  her,  procur- 
ed a  few  flool  s,  aijd  brought  on  a  gentle  perfpira- 
ration.  Her  lochia  and  milk  began  to  diminifh, 
fhe  got  out  of  bed  for  the  firft  time  in  the  evening,, 
hut  was  fo  fick  that  ihe  could  not  bear  up,  and  was 
immediately  put  into  bed  again.  Her  pulfe  was  ve- 
ry quick,  and  her  diforder  feemed  to  be  increafmgo 

In 


APPENDIX.  291 

In  the  morning  and  evening  of  the   fixth,  fhe 
took  a  little  rhubarb  and  nitre* 

On  the  ninth  day  I  was  defired  to  vifit  her  by 
the  gentleman  who  had  delivered  her.     I   was   in- 
formed that  fhe  had  feldom  fat  up  in  bed,  and  on- 
ly once  been  out  of  it.     The  houfe  was  fituated  in 
the  moft  crowded  part  of  the  town.     The  room  fhe 
lay  in  was  about  fix  yards  in  length  and  five  in 
breadth  ;  but  it  was   very  low,  its  height  not  ex- 
ceeding fix  feet  and  a  half.     It  was  not  however 
remarkably  hot,  though  a  fire,  at  which  the  victu- 
als of  the  family  were  drefTed,  was  kept  conftantly 
in  it  :  The  fire  was  at  a  confiderable  diftance  from 
the  bed.    The  nurfe  and  both  the  children  lay  in  the 
fame  bed  with  the  patient,  and  her  hufband  lay  in 
another  in  the  fame  room.     The  furgeon  who  was 
employed,  very  prudently  ordered   the  door,  and 
fometimes  a  window,  to  be  opened  in  the  daytime  ; 
but  his    directions  were  not  complied  with,   and 
when  he  had  himfelf  opened  them,  they  were  im- 
mediately fhut  upon  his  leaving  the  chamber.  She 
had  every  day  wine,  though  in  no  great  quantity, 
put  into  her  gruel,   and  no  acids   were  given  her. 
She  complained  of  frequent  motions  to  make  wa- 
ter ;  of  pain,  forenefs,  tenfion,  and  fwelling  in  the 
lower  part  of  the  abdomen.     Upon  examining  the 
parts  with  the  greateft  attention,  I  found  that  her 
T  2  complaints 


292  APPEND!  X. 

complaints  were  confined  to  the  region  of  the  u-te- 
"  rus  and  bladder ;  and  that  the  {Welling  was  p  ^rfeftly 
circumfcribed ;  and  that  neither  the  pain,  the  fw ell- 
ing,  nor  the  forenefs,  extended  beyond  the  half  way 
from  tfee  pubis  to  the  navel ;  nor  was  there  at  that 
time  any  reafon  to  apprehend,  either  from  the  na- 
ture of  the  fymptoms,  or  the  touch,  that  there  was 
any  inflammation,  or  other  diforder.  either  in  the 
ftomach,  om.-ntum,  or  inteftines,  if  we  except  a 
gentle  forenefs  with  which  it  was  affected. 

The  gentleman  who  was  employed  for  her,  in- 
troduced a  catheter  into  her  bladder,  that  he  might 
difcover  whether  it  was  diftende  1  with  water  ;  but 
it  did  not  contain  above  three  or  four  fpoonfuls. 
Upon  preffing  the  catheter  againft  the  fundus  of 
the  bladder,  fhe  complained  that  there  was  the  feat 
of  her  diforder.  She  was  thirfty,  but  her  tongue 
was  very-  little  altered  from  its  natural  Hate ;  it 
having  neither  a  white  nor  a  brown  fur  upon  it. 
She  had  very  little  milk,  and  her  lochia  were  re- 
duced to  a  fmall  fanious  difcharge.  She  had  nei- 
ther rigours,  vomitings,  nor  eruptions.  The  heat 
of  her  fkin,  and  the  exceflive  quicknefs  of  her 
pulfe,  which  beat  nolefs  than  160  times  in  a  min- 
ute, were  her  only  alarming  fymptoms.  I  feveral 
times  examined  her  pulfe  by  a  flop  watch,  when 
ihe  was  neither  fluttered  nor  in  great  pain,  and 
conftantly  found  them  the  fame.  From  this  fin- 
gle  circumftance,  upon  my  firfl  viiit  I  prognofticat? 

ed 


APPENDIX.  8 


>93 

ed  that  me  could  not  recover.  Small  dofes  of 
emetic  tartar,  which  gently  puked  her,  were  ad- 
miniflered  feveral  times  today.  Buttermilk  poffets 
and  buttermilk  were  ordered  for  hef  common 
drink,  and  in  the  evening  fhe  got  out  of  bed. 

On  the  loth,  her  pulfe  beat  only  128  .times  in  a 
minute,  her  belly  was  rather  fofter,  me  had  fever- 
al flools,  and  feemed  no  worfe  in  any  refpe6L  On 
the  nth,  the  lower  part  of  the  belly  about  the  ute- 
rus was  fofter,  but  the  whole  abdomen  began  t<5 
fwell.  Her  pulfe  beat  160  times  in  a  minute.  She 
had  many  flools  ;  and  fait  of  wormwood,  with  the 
juice  of  lemons,  was  frequently  given  in  the  aft  of 
fermentation.  Upon  the  12th,  the  whole  abdomen 
was  much  diftended,  and  the  pain,  which  now  ex- 
tended itfelf  to  her  fides,  was  fo  violent,  that  her 
cries  alarmed  the  neighbours.  That  we  might 
procure  her  a  little  eafe,  we  were  obliged  to  apply 
an  anodyne  fomentation  to  her  belly,  and  to  give 
her  opiates  mixed  with  ipecacuanha.  She  had  a 
great  many  ftools,  and  her  tongue  had  a- white  fur 
upon  it. 

Her  loofenefs  flopped,  and  fhe  had  not  much 
pain  upon  the  13th,  but  her  belly  was  greatly 
diftended.  Her  pulfe  was  fo  quick  as  hardly  to 
be  counted.  Her  extremities  were  cold.  She  re* 
tained  her  fenfes  to  the  very  lafl  moment ;  and  ex- 
pired about  nine  o'clock  in  the  evening. 

T  3  DISSECTION. 


294  A  P  P  ETtf  D  I  X. 


DISSECTION. 

The  furgeon  who  attended  her,  opened  her  body 
the  next  day,  in  the  prefence  of  another  furgeon, 
and  two  young  gentlemen  of  the  profeffion.  My 
being  called  to  a  diftance  prevented  my  attendance  ; 
but  he  told  me  that  the  appearances  were  exactly 
correfpondent  to  thofe  which  he  had  obferved  in 
London,  in  fubje&s  who  had  died  of  the  true  ma- 
lignant puerperal  fever.*  The  omentum  was  al- 

mofl 

*  The  great  variety  of  the  appearance  on  diffeftion,  and  the  little  certainty 
as  yet  obtained  from  it  with  regard  to  the  principal  feat  of  the  difeafe,  are 
fully  (hewn  in  the  following  paffage  : 

"  In  about  forty  women  whom  I  have  had  opportunity  of  infpefting,  all 
or  fome  of  the  following  appearances  have  been  obferved.  The  uterus  or 
its  appendages  were  in  a  flate  of  inflammation,  and  fometimes  mortified. 
The  os  uteri,  and  that  part  of  the  uterus  to  which  the  placenta  had  adhered, 
had  generally  a  morbid  appearance.  Small  abfceffes  were  formed  in  the 
fubftance  of  the  uterus,  or  in  the  cellular  membrane  which  connects  it  to  the 
adjacent  parts.  The  bladder  was  inflamed.  The  omentum  was  very  thin, 
irregularly  fpread,  and  in  a  ftate  of  inflammation.  The  inteftines  were  in- 
flamed, chiefly  in  the  peritonseal  coat,  adhered  in  many  places,  and  were 
much  inflated.  Inflammatory  exfudations,  and  ferum  extravafated  in  the 
cavity  of  the  abdomen,  have  been  found  in  various  quantities  ;  but  thefe  were 
in  a  lefs  degree  when  the  patient  had  laboured  under  a  long  continued  purg- 
ing. Large  flakes  of  coagulable  lymph  were  found  in  the  cavity  of  the  abdo- 
men, which  have  been  often  miftaken  for  diflblved  portions  of  omentum. 
It  muft  indeed  be  acknowledged,  that  the  information,  acquired  in  this. 
iearch,  has  not  been  equal  to  the  care  or  to  the  afiiduity  with  which  it  has 
been  made*'1 

Denman  on  the  Puerperal  Fever. 
Second  Edit,  p,  29  and  30. 


APPENDIX.  295 

tnoft  wholly  diiTolved  :  detached  pieces  floated  in 
the  abdomen,  which  contained  almoft  three  pints 
of  thick  purulent  matter,  and  of  ferous  fluid.  The 
ilomach  and  inteftines  were  much  inflated,  and 
the  interlines  were  glued  to  each  other,  and  to  the 
peritonaeum  ;  but  in  fuch  a  manner  that  they 
might  be  pulled  afunder  without  tearing  their 
coats.  They  appeared  to  be  pafted  together  by  a 
kind  of  gluten  ;  and  inflammation  feemed  not  to 
have  been  in  the  leail  the  caufe  of  their  adhefion. 
Some  of  the  fmaller  veffels  feemed  to  be  a  little 
turgid  with  blood.  He  did  not  any  where  obferve 
the  appearances  of  inflamma-tion  or  mortification. 
The  left  ovary  was  rather  larger  than  the  other, 
but  perfectly  found.  The  womb,  which  was  not 
contracted  to  its  ufual  fize,  was  capable  of  receiv- 
ing an  hen's  egg  ;  and  upon  cutting  it  open  its 
fides  were  found  to  be  three  quarters  of  an  inch  in 
thicknefs.  The  inward  coat  appeared  to  be  en- 
tirely black,  as  if  in  a  flate  of  mortification  ;  but 
upon  wiping  it  clean,  the  blacknefs  was  found  to 
be  nothing  more  than  the  putrid  lochia  and  de- 
ciduous membrane,  which  had  covered  the  whole 
infide  of  the  uterus.  There  was  not  the  leafl  ap- 
pearance of  laceration,  or  of  any  other  external 
injury. 


T  4  REMARKS. 


29<5  A  P  P  E  N  D~I  X. 


REMARKS. 

' 

The  fituation  of  the  patient's  apartment,  which 
was  in  the  clofeft  part  of  the  town  ;  the  remarka- 
ble lownefs  of  the  room  ;  the  vitiated  ftate  of  the 
air  from  the  breath  of  fo  many  perfons  ;  the  hori- 
zontal pofition  of  the  patient  for  many  days  to- 
gether ;  her  complaint,  at  firft,  confined  to  the 
lower  part  of  the  abdomen,  and  afterwards  gradu- 
ally rifmg  higher  ;  the  quicknefs  of  her  pulfe  in 
the  beginning  of  the  difeafe,  and"  its  beating  four 
days  before  death  160  times  in  a  minute  ;  are  cir- 
cnmftances  which  merit  the  utmoft  attention.  So 
quick  a  pulfe  is  feldom  produced  by  inflammation, 
when  unattended  with  depofitions  or  abforptions 
of  matter,  though  accompanied  with  the  moft  vio- 
lent pain.  The  moft  inflammatory  gout,  when 
productive  of  the  moft  excruciating  torture  ;  the 
inoft  violent  paroxifms  of  the  ftone  either  in  the 
kidneys  or  the  bladder,  or  in  the  paffage  from  one 
of  them  to  the  other  ;  the  exceffive  and  almoft  in- 
tolerable torture  arifing  from  a  gall  ftone  paffing 
through  the  duels  ;  the  pain  and  inflammation  in 
the  pleurify,  the  iliac  paflion,  or  the  cholera  mor- 
bus  ;*  nay  even  thofe  arifing  from  the  ftrangula- 

tion 

*  The  firft  attack  of  this  fever  is  fometimes  fo  violent,  that  in  many  re- 
fpe&s  it  vefembles  the  cholera  morbus  ;  for  the  pain,  ficknefs,  and  burning 
heat  in  the  floraach  and  bowels,  are  ajmoft  the  fame  j  and  the  bile,  in  great 

profufion, 


APPENDIX. 

tion  of  the  inteftines,  or  omentum,  or  from  any  of 
the  principal  operations  in  furgery,  as  lithotomy, 
amputation,  Sec.  'except  where  a  mortification  is 
come  on  and  the  patient  is  in  the  agonies  of  death, 
do  not  occafionfo  rapid  a  pulfation.  A  pulfe  fo 
exceffively  quick  is  feldom  produced  by  pain, 
though  accompanied  by 'inflammation.  A  quick 
pulfe  is  however  the  pathognomonic  fymptom  of 
all  abforptions,  whether  they  be  produced  by  ul- 
cers in  the  lungs,  in  the  joints,  or  in  any  other  part 
of  the  body ;  though  unattended  by  pain  or  in- 
flammation. I  have  known  an  exceffive  accelera- 
tion of  the  pulfe  proceed  from  a  fmall  wound  in 
the  joint  of  the  knee,  attended  with  abforption, 
where  the  patient  was  perfectly  well  immediately 
fcefore  the  accident. 


,,  <JtMte,       CASE       XVIII. 

BEING  called  to  Afhtonunderline,  a 
town  in  this  neighbourhood,  to  fee  a  patient,  as  I 
was  talking  with  Mr.  Greaves,  an  ingenious  young 
furgeon  of  that  place,  a  corpfe  with  a  white  fheet 
thrown  over  the  coffin  was  carrying  through  the 
ftreets  to  be  buried.  Concluding  from  this  circum- 
ftance,  that  itwas  a  woman  who  haddiedin  childbed, 


•profufion,  is  discharged  upwards  and  downwards  ;  though  in  the  firft,  the 
pulfe  is  more  quid  and  weak. 

Leakc,  p,  47. 


298  A  P  P  E  N  D  I  X. 

I  inquired  into  the  nature  of  her  diforder.  He  in- 
formed me  (he  died  of  a  puerperal  fever.  Her 
name  was  Ann  Leek,  a  poor  woman,  about  35 
years  of  age.  The  particulars  were  as  follow  :  He 
was  called  to  her  in  the  middle  of  the  eighth 
month  of  her  third  pregnancy,  for  a  flooding,  which 
was  fo  violent  that  the  blood  ran  through  not  on- 
ly the  bed,  but  even  the  floor  into  the  room  below ; 
but  by  taking  plentifully  of  the  bark,  Ihe  recover- 
ed and  went  to  her  full  time,  when  fhe  was  deliv- 
ered by  a  midwife  on  the  i6th  of  November,  1772, 
and  had  a  very  eafy  natural  labour. 

He  heard  no  more  of  her  till  the  23d,  when  he 
found  her  with  a  very  quick  pulfe,  brown  dry 
tongue,  and  delirious.  She  had  a  great  number  of 
petechie  ;  and  her  ftools,  which  carne  from  her  in- 
voluntarily, were  very  offenfive.  Her  friends  in- 
formed him  that  fhe  was  feized  a  few  days  after 
her  delivery  with  a  fhivering  fit,  fucceeded  by  vom- 
iting and  loofenefs,  and  complained  much  of  her 
belly.  She  died  upon  the  24th,  being  the  ninth 

day  from  her  delivery. 

. 

• 

;     '.;.' 

Upon  inquiring  into  the  mod  probable  caufes 
of  her  death,  Mr.  Greaves  informed  me  that  the 
room  fhe  lay  in  was  intolerably  ofFenfive,  owing  to 
a  veflfel  containing  about  four  gallons,  kept  there  as 
a  refervoir  for  all  the  urine  of  the  family,  which 

was 


APPENDIX. 

was  emptied  once  a  week  for  the  ufe  of  the  dyers, 
but  was  nevei\cleaned. 

\      :  -;..v:.  i 

CASE       XIX. 

ABOUT  five  years  ago,  Mrs.  W — , 
who  was  then  twenty  one  years  of  age,  was  deliv- 
ered of  her  firft  child,  as  fhe  fat  upon  the  knee  of 
an  afliftant.  She  was  confined  to  her  bed  till  the 
fifth  day  after  her  delivery,  and  during  thfs  time 
fcarcely  ever  fat  up.  On  the  fifth  and  fixth  days 
fhe  was  raifed,  that  her  bed  might  be  made,  but 
ivas  not  able  to  continue  up  longer  than  was  necef- 
fary  for  that  purpofe  ;  and  fhe  was  afterwards  a- 
gain  confined  to  her  bed  eight  fucceffive  days  with- 
out getting  out  of  it.  During  this  time  fhe  was  at- 
tacked by  a  violent  fever,  attended  with  miliary  e- 
ruptions,  both  of  the  white  and  red  kind.  Of  this 
fever  fhe  perfectly  recovered  ;  but  upon  returning 
to  her  ufual  exercife,  fhe  was  feized  with  a  prolap- 
fus  vagince,  which,  except  in  the  latter  end  of  her 
pregnancies,  hath  ever  fince  continued. 

On  the  feventh  of  January  1773,  fhe  was  deliv- 
ered, by  a  gentleman  of  this  town,  of  her  third 
child,  as  fhe  fat  upon  the  knee  of  an  afliftant.  He 
informed  me  that,  as  foon  as  the  child  was  born,  he 
pulled  gently  at  the  navel  firing ;  and  that  a  fmart 

pain 


APPENDIX. 

pain  came  on,  which  totally  inverted  the  uterus, 
forcing  it  down,  to  the  fize  of  his  hand,  through 
the  labia,  with  the  placenta  Mill  adhering  to  its 
fundus.  The  nature  of  her  cafe  immediately 
flruck  him  ;  but  to  be  more  perfectly  fatisfied,  af- 
ter making  an  apology  for  fo  uncommon  a  requeft, 
he  called  for  a  candle,  and  found  he  was  not  mif- 
taken  in  his  conjecture.  He  carefully  feparated 
the  placenta  from  the  uterus  with  his  fingers,  and 
attempted,  but  in  vain,  to  reftore  the  womb  to  its 
prifline  ftate.  He  was  only  able  to  puih  it  up  in- 
to the  vagina.  In  this  fituation  me  was  put  to  bed, 
and  he  came  to  me  to  defire  I  would  vifither  along 
with  him.  In  about  an  hour  after  this  I  faw  her, 
and  found  the  uterus  about  the  fize  of  a  large  new 
born  infant's  head,  totally  inverted,  and  lying  with- 
in the  vagina.  She  was  in  great  pain,  had  loft 
much  blood,  was  very  faint,  and  no  pulfe  could 
be  felt  in  either 'afin^THRSSiptea  '  to  return  the 
uterus  to  its  j>Iace  by  pufhing  at  its  fundus  ;  but 
as  this  was  attended  with  great  pain,  brought  on  a 
violent  forcing  down,  and  was  accompanied  with 
much  lofs  of  blood,  I  for  a  while  defifted,  from  an 
apprehenfion  that  fhe  might  die  under  my  hands. 
I  now  prefcribed  her  an  opiate,  with  a  few  drops  of 
vitriolic  elixir. 

Upon  farther  confideration  of  her  cafe,  I  was  of 
opinion  that  the  body  of  the  uterus  was  too  large 

to 


APPENDIX.  301 

to  pafs  through  its  neck,  which  was  a  little  con- 
tracted ;  therefore  in  a  few  minutes  after  fhe  had 
taken  the  opiate  and  vitriolic  drops,  without 
waiting  for  their  effects,  I  haftened  to  reduce 
it  by  the  following  mode  of  practice,  which  I  be- 
lieve to  be  entirely  new,  and  which  had  never  be- 
fore occurred  to  me.  I  grafped  the  body  of  it  in 
my  hand,  and  held  it  there  for  fome  time,  in  order 
to  leffen  its  bulk  by  compreflion.  As  I  very  foon 
perceived  that  it  began  to  diminiih,  I  perfevered,  ; 
and  foon  after  made  another  attempt  to  reduce  it, 
by  thrufling  at  its  fundus.  It  began  to  give  way. 
I  continued  the  force  till  I  had  perfectly  returned 
it,  and  had  infmuated  my  hand  into  its  body.  I 
now  withdrew  my  hand  a  little  and  endeavoured 
to  clofe  the  os  uteri  by  aflifiing  it  in  its  contrac- 
tion with  my  fingers.  It  was  no  fooner  reduced, 
than  the  pulfe  in  her  wrift  began  to  beat.  She  re- 
covered as  faft  as  we  could  wifli,  and  without  a 
(ingle  alarming  circumftance. 


REMARKS. 

Had  not  the  idea  occurred  to  me  of  its  being 
practicable  to  dimimfh  the  uterus  by  compreflion, 
I  am  fatisfied  I  fhould  not  have  been  able  to  have 
replaced  it  ;  and  though  my  firfl  attempt  to  re- 
duce it  without  compreflion -diftrefled  my  patient 

greatly, 


302  APPENDIX. 

greatly,  yet  the  method  I  afterwards  purfued,  feem- 
ed  to  be  attended  with  little  pain. 

Several  circumflances  might  probably  contribute 
to  this  accident  ;  the  prolapfus  vagina;,  with  which 
the  patient  had  been  fometime  troubled — the  pofi- 
tion  fhe  was  in  at  the  time  of  delivery — the  fud- 
den  delivery  of  the  child — the  adhefion  of  the  pla- 
centa exactly  to  the  bottom  of  the  uterus — the  in- 
fertion  of  the  funis  in  the  very  center  of  the  pla- 
centa, and  the  pulling  at  the  navel  firing  too  foon 
after  the  birth,  before  the  uterus  had  fufficiently 
contracted  itfelf,  and  whilft  the  woman  was  nearly 
in  an  upright  fituation. 

Cafes  of  inverted  uteri  are  not  very  frequent ; 
and  the  recoveries  of  patients  who  had  met  with 
fuch  accidents  have  been  extremely  uncommon. 
The  reafon  they  fo  feldom  occur,  may  probably 
with  juftice  be  attributed- to  the  neceffity  of  fo  ma- 
ny concurring  circumflances.  The  proper  means 
of  returning  the  inverted  uterus  not  being  before 
difcovered,  and  the  want  of  fpeedy  affiflance  may 
be  the  reafons  why  fo  few  have  recovered.  I 
know  but  of  two  written  inflances  of  recovery  af- 
ter a  total  inverfion  ;  one  is  mentioned  by  Ruyfch, 
Obf.  10,  where  the  wife  of  a  certain  Jew  was  the 
patient,  the  other  by  Dr.  Harvie  in  his  Praftical  Di- 
reSi0ws,p.  21.  Le  Motte,  indeed,  1.  5.  c.  10.  Obf, 


APPENDIX.  303 

384.  mentions  another  cafe  in  which  the  patient 
recovered,  but  in  this  he  does  not  feem  to  think 
that  there  was  a  total  inverfion. 

My  father  informed  me  that  he  was  many  years 
ago  fent  for  to  a  woman  in  this  fituation,  about  ten 
miles  from  hence  ;  but  fhe  died  before  his  arrival. 
She  had  been  delivered  as  fhe  fat  upon  the  knee  of 
an  afliftant,  and  the  midwife  had  by  pulling  at  the 
navel  firing  too  foon  after  the  delivery,  totally  in- 
verted the  uterus.  About  eight  years  ago  I  was  fent 
for  myfelf,  and  in  a  cafe  exactly  fimilar.  Th$ 
woman  lived  about  a  mile  from  hence,  and  as  I 
was  then  from  home,  Dr.  Aikin,  at  that  time  my 
pupil,  went  in  my  flead.  The  patient  died  as  he  en- 
tered the  chamber.  He  found  the  inverted  uterus 
beyond  the  labia,  and  the  placenta  Hill  adhering. 

Thofe  who  would  wifh  to  fee  more  hiftories  of 
thefe  truly  alarming  cafes,  may  confult  Ruyfch, 
Obf.  10  and  26  ;  Mauriceau,  Obf.  355  and  685  ; 
Giffard's  Cafes  in  Midwifery,  cafe  176,  p.  421  ; 
Chapman,  cafe  29,  p.  197  ;  La  Motte,  Lib.  5, 
chap.  10,  Obf.  384  ;  Smellie's  Works,  vol.  3, 
Collection  44,  cafes  3  and  4,  p.  494  and  495  ; 
and  Dr.  Hunter's  MSS.  Ledure*  on  the  Gravid 
Uterus. 

This  cafe  likewife  helps  to  prove  that  prolapfufes 
of  the  vagina,  or  bearings  down;  as  they  are  com-^ 

monly 


go4  A  P  P  E  N  D  I  X. 

rnorzly  called,  are  not  occafioned  by  too  early  get* 
ting  out  of  bed  after  delivery  ;  as  this  woma  n  in 
her  firft  lying  in  never  got  out  of  bed  till  the  fifth 
day,  and  fcarcsly  ever   fat  up  in  it  during   that 
time,;  nay  fhe   was  totally  confined   to  her  bed 
fourteen  days,  except  on  the  fifth  and  fixth  days  - 
that  (he  was  raifed,  whilft  her  bed  was  made  ;  and 
yet  when  (he -returned  to  her  ufual  exercifes,   fhe 
perceived  the  ^r0/<7jfr/k$  vagina?.     It  muft  therefore 
have  been  owing  to  Tome  other  caufe,  probably  to 
the  upright  pofition  during  labour,  and  the  too 
hafty  delivery  .of  the  fhoulders.    ^ 

C     A     S     E         XX. 

HANNAH  NORBURY  of  Biakeiy,  a 

fmall  village,  about  three  miles  from  Manchefter, 
aged  27,  was  delivered  of  her  firft  child,  by  a  mid- 
wife in  the  neighbourhood,  on  the  4th  of  March, 
!773>  as  fhe  fat  ,upon  the  knee  of  an  affiftant.  She 
had  an  eafy  natural  labour,  and  the  placenta  came 
away  without  difficulty.  She  was  of  a  corpulent 
habit,  but  fhe  had .  enjoyed  pretty  good  health 
except  a  trifling  cough  which  fhe  had  been  troub- 
led with  for  about  eighteen  months,  and  at  the 
latter  end  of  her  pregnancy  fhe  had  been  for 
the  moil  part  coftive.  During  her  labour  fhe  com- 
plained of  the  headach,  which  continued  after- 
wards. She  was  kept  in  a  continual  fweat,  and 

never 


APPENDIX. 

never  once  fat  up  in  bed  till  the  third  day  in  the 
afternoon,  when  fhe  got  out  of  it  for  a  little 
while ;  the  child  was  applied  to  her  breads  this 
day  for  the  firft  time,  the  lochia  were  almoft  flop- 
ped, and  fhe  had  a  fhivering  fit  in  the  evening  fuc- 
ceeded  by  a  burning  and  a  fweating  fit.  On  the 
fourth 'day  her  breafls  were  a  little  troublefome, 
but  by  rubbing  with  a  little  oil  they  grew  eafy. 
On  the  5th,  had  another  fhivering  fit.  On  the  6th, 
had  a  ftool  which  was  the  firft  fhe  had  had  fince 
the  day  before  her  delivery.  On  the  8th  fhe  was 
feized  with  a  bilious  vomiting,  and  a  loofenefs  ; 
her  urine  was  high  coloured  and  muddy,  and  fhe 
coughed  much  in  the  night.  She  had  a  delirium, 
but  her  hufband  obferved  that  it  was  only  at  fuch 
times  when  fhe  lay  upon  her  back,  but  that  when 
fhe  lay  upon  her  fide  fhe  was  quite  free  from  it. 

i 
,  On  the  gth    fhe  remained    much  in  the  fame 

ftate.  In  the  evening  I  was  applied  to,  and  order- 
ed her  tartar  emetic  and  calx  of  antimony,  which 
puked  her,  and  eafed  her  ftomach  and  bowels. 

On  the  loth  I  faw  her  for  the  firft  time.  Her 
pulfe  were  fmall,  and  beat  176  ftrokes  in  a  min- 
ute ;  her  voice  faultered  ;  fhe  was  fometimes  delir- 
ious, her  eyes  were  red  and  looked  wild,  and  fhe 
faid  her  head  ached.  She  did  not  make  any  com- 
plaint of  her  belly  ;  but  when  I  kid  my  hand  up*' 
U  w 


306  APPENDIX. 

on  it  below  the  navel,  in  any  part  of  the  hypogaf- 
tric  region,  it  was  fo  exceedingly  tender  that  me 
could  fcarce  bear  me  to  touch  it,  but  about  the 
navel,  and  above  it,  fhe  made  not  the  leaft  com- 
plaint though  I  preffed  ever  fo  hard.  Her  bed 
was  placed  within  half  a  yard  of  the  fire  ;  and  her 
friends  informed  me  that  fhe  had  fweated  'much 
fince  her  delivery,  that  her  only  food  had  been 
meal  or  groat  gruel,  given  warm  with  a  little  wine 
in  it,  and  once  it  was  mixed  with  a  fmall  quan- 
tity of  malt  liquor.  I  ordered  her  the  fait  of 
wormwood  and  juice  of  lemons  in  the  a6l  of  effer- 
vefcence,  and  gave  her  leave  to  drink  butter  milk 
poffet,  which  fhe  had  before  afked  for,  but  it  had 
been  denied.  The  lochia  were  flopped  except  a 
little  brown  water.  She  had  not  much  milk,  but 
the  child  continued  to  fuck  her.  On  the  nth  I 
faw  her  again  :  Her  pulfe  was  fo  fmall  and  quick 
as  not  to  be  counted  ;  me  had  convulflve  fpafms, 
and  was  not  able  to  fpeak  or  take  any  medicines. 
She  had  one  flool  this  day,  and  no  vomiting. 

On  the  i2th,   ftools   and  urine  came  from  her 
involuntarily,  and  fhe  died  in  the  evening, 

REMARKS. 


I  muft  obferve  that   the  room  in  which  this  worn- 
an  lay  had  no  door  to  it,  nor  were  there  any  cur- 
tains 


APPENDIX.  307 

tains  to  the  bed  ;  therefore  I  believed  there  could 
not  be  much  putrid  air  except  what  was  confined 
under  the  bed  clothes.  The  mifmanagement  chief- 
ly confifted  in  keeping  her  in  an  horizontal  pofi- 
tion,  for  three  days  fucceflively,  without  once  fit- 
ting up  in  bed — in  permitting  her  to  be  feven  days 
without  a  flool — in  her  being  too  much  heated  by 
the  fire,  too  many  bed  clothes,  and  drinking  warm 
liquids  with  wine  in  them  ;  in  fweating  too  much, 
and  not  being  allowed  any  cool  acefcent  liquors. 


DISSECTION. 

Upon  opening  the  abdomen  about  fourteen 
hours  after  death,  there  was  not  the  lead  difagree- 
able  fmell  ;  the  omentum  was  large,  perfectly 
found,  fpread  regularly  over  the  inteftines,  and  of 
a  natural  colour,  except  a  little  of  the  lower  edge 
which  was  not  fo  bright  a  yellow.  The  inteflines 
fhewed  not  the  leaft  fign  of  inflammation,  and 
were  perfectly  found :  They  were  not  glued  to  one 
another,  nor  was  there  any  matter  or  watery  fluid 
floating  in  the  cavity  of  the  abdomen.  The  uterus 
was  fomething  larger  than  my  fift,  of  a  natural 
colour,  but  flaccid  ;  upon  cutting  it  open,  the  in- 
fide  appeared  black  ;  but  I  eafily  wiped  off  the 
blacknefs,  which  feemed  to  be  nothing  more  than 
fome  remains  of  the  fpongy  chorion  and  fome  par* 
••-.rir1  U  &  deles 


308  APPENDIX. 

tides  of  blood.     Her  friends  being  very  averfe  to 
any  farther  examination,  I  was  obliged  to  defift. 

CASE     XXI. 

ANN  WORTHINGTON,aged 
twenty  fix,  was  delivered  of  her  firft  child,  by  a 
gentleman  of  pretty  confiderable  pra&ice,  on  Fri- 
day the  i6th  of  June  1775,  about  noon.  He  in- 
formed me  that  in  attempting  to  bring  away  the 
placenta,  the  navel  firing  broke  :  He  afterwards 
tried  to  extract  it  by  the  manual  operation,  but 
found  the  uterus  fo  contracted  in  the  middle,  like 
an  hour  glafs,  that  he  thought  it  moft  prudent  to 
defift  for  the  prefent,  and  gave  her  an  opiate.  He 
defired  I  might  be  called  in,  and  I  faw  her  about 
five  hours  after  her  delivery.  I  found  Ihe  had 
flooded  much  ;  her  pulfe  was  fmall,  and  me  was 
very  pale  with  the  lofs  of  blood  ;  but  the  flood- 
ing had  now  much  abated,  and  fhe  feemed  tolera- 
bly eafy.  I  therefore  did  not  examine  her,  nor 
order  her  any  thing,  but  to  continue  to  take  an  acid 
•julep,  which  had  been  prefcribed  her ;  to  drink 
cooling  fubacid  liquors  ;  to  keep  the  doors  and 
windows  open,  as  the  weather  was  excefiively  hot; 
and  to  fit  up  in  bed  as  often  as  poflible,  if  (he  did 
not  flood.  The  next  morning  me  got  out  of  bed, 
which  was  made,  and  her  linen  qhanged,  and  a 
was  inje£led, 

la 


APPENDIX.  309 

In  about  30  hours  after  delivery,  as  there  was  no 
fign  of  the  placenta  coming  away,  and  the  weather 
was  remarkably  hot,  I  was  afraid  of  its  growing 
putrid,  and  producing  a  putrid  fever  ;  I  therefore 
examined  her  for  the  firft  time,  in  order  to  affift 
in  bringing  it  away  ;  but  found  that  the  contrac- 
tion flill  remained,  and  the  placenta  was  quite  out 
of  my  reach  without  ufing  violence.  The  lochia 
were  in  proper  quantities,  and  not  ofFenfive. 

On  the  fecond  night  fhc  had  a  fevere  fhiveiing 
fit,  fucceeded  by  a  hot  one,  and  terminated  by  a 
fweat.  In  the  morning  fhe  took  a  vomit  of  ipecac- 
uanha in  powder,  and  got  up  out  of  bed. 

On  the  third  day  had  another  rigour,  got  out  of 
bed  again  in  the  evening,  and  ftaid  up  an  hour. 
Being  coftive,  and  complaining  much  of  her  head, 
and  her  belly  being  fwelled  and  tender,  with  her 
pulfe  120,  an  aperient  mixture  was  prefcribed,  but 
that  not  operating,  fhe  took  two  grains  of  calomel, 
and  a  quarter  of  a  grain  of  tart.  emet.  which  gave 
her  feveral  ftools,  and  fhe  omitted  the  mixture. 

The  next  day  being  the  fourth,  when  the  lochia 
grew  very  offenfive,  warm  water*  was  injected  per 

vaginam  ; 

*  In  the  puerperal  fever  whenever  the  lochia  are  ofFenfive,  warm  water 
fhould  be  frequently  inje&ed  into  the  uterus  by  means  of  a  fyringe  whic^.- 
has  a  thick  fyphon  and  a  little  curved  ;  and  I  am  inclined  to  think  that  fuch 
injections  would  be  very  ferviceable  in  all  puerperal  fevers,  if  properly  per* 
formed, 

U3 


310  APPENDIX. 

vaginam  ;  me  took  antimonial  powders,  got  out 
of  bed  twice  a  day,  ftaid  up  at  leaft  an  hour  every 
time,  and  often  fat  up  in  bed. 

On  the  fifth  day  had  another  rigour  :  Took  fait 
of  wormwood  and  juice  of  lemons  in  the  acl;  of  ef- 
fervefcence  every  three  hours  ;  took  every  day  great 
quantities  of  buttermilk,  oranges  and  lemons,  and 
the  doors  and  windows  were  kept  conftantly 
open. 

On  the  fixth  day  fhe  got  out  of  bed  three  times, 
flaying  up  an  hour  and  half  each  time  ;  continued 
the  neutral  mixture,  and  the  antimonial  powders, 
which  kept  the  inteflinal  canal  fufficiently  open, 
having  feveral  loofe  ftools  every  day. 

On  the  feventh  night  a  few  parny  came  on,  and 
fhe  parted  with  the  placenta,  which  was  very  pu- 
trid, except  one  part,  which  feemed  not  to  have 
been  long  feparated  from  the  uterus. 

On  the  eighth  day  fhe  was  much  better.  On 
the  tenth  a  diarrhea  came  on,  which  on  the  elev- 
enth was  very  fevere  ;  fhe  therefore  took  a  grain  of 
ipecacuanha  ;  and  a  few  grains  of  rhubarb,  which 
•puked  her,  and  her  loofenefs  abated, 

On 


APPEND  IX.  311 

On  the  twelfth  a  flight  preparation  of  the  bark 
was  ordered  ;  and  on  the  thirteenth*  (he  faid  {he 
had  no  complaints,  except  too  much  milk  in  her 
breads  ;  fhe  kept  out  of  bed  moft  of  the  day.  From 

that  time  fhe  perfectly  recovered. 

• 

•    • 
CASE       XXII. 

' 

JYlRS. ,  aged  25,  remarkable  for 

good  health  arid  fpirits,  and  an  amiable  difpofition, 
being  arrived  at  the  fulleft  period  of  geftation  of  her 
fourth  child,  was  feized  with  labour  pains  on  Satur- 
day morning  the  6th  of  November,  1 784,  and  in  two 
hours  after  was  delivered  by  a  careful  and  experienc- 
ed midwife  of  a  fine  lufiy  boy.  During  her  labour, 
fhe  (laid  up  till  a  fhort  time  before  her  delivery, 
when  fhe  was  put  to  bed.  The  midwife  was  only 
an  hour  and  a  half  in  the  room  with  her,  andnoth- 
ing  happened  during  that  time  worth  relating,  ex- 
cept the  patient  faying  to  the  midwife,  /  am  not  as, 
lam  ufed  to  be  ;  to  which  the  midwife  anfwer- 
ed^  Indeed,  madam,  you  are,  and  are.  doing  •  extremely 
well ;  fhe  replied,  /  am 'too.  old  a  prattitivner  to  be 
deceived ,-  and  I  tell  you,  I  am  not  doing  as  I  ufed  to  do. 

On 

*  In  all  the  cafes  which  I  have  mentioned,  the  number  of  days  from  de- 
livery, it  muft  be  underftood  that  the  day  of  delivery  is  included.  I  thought 
it  neceflary  to  take  notice  of  this  circumftance,  as  I  find  fome  Authors  ob- 
jferve  a  contrary  method. 


312  APPENDIX. 

On  the  third  day  after  delivery,  me  got  up  whilft 
the  bed  was  made,  and  that  day  ate  a  little  chicken* 

On  the  fourth  day  {he  fat  up  half  an  hour.  This 
day  her  milk  was  a  little  troublefome,  ^attended 
with  a  flight  degree  of  feverifhnefs,  and  her  breafls 
were  gently  rubbed  with  brandy  and  pommade. 
Her  milk  gradually  left  her.  Her  belly  was  regu- 
larly kept  open  with  caflor  oil,  and  the  lochial  dif- 
charge  was  proper  both  in  quantity  and  quality. 
She  had  a  conftant  fire  in  her  room,  but  I  could  not 
learn  that  it  was  kept  hot,  the  door  being  frequent- 
ly open. 

On  Friday  evening  the  feventh  from  delivery, 
betwixt  nine  and  ten  o'clock,  as  fhe  was  undrefT- 
ing,  fhe  remarked  to  her  woman  that  fhe  never  was 
itronger  or  better  for  the  time,  than  fhe  was  at  that 
inftant.  But  about  ten  o'clock,  as  fine  was  getting 
into  bed,  fhe  complained  of  giddinefs  in  her  head, 
and  in  a  few  minutes  after,  was  feized  with  unufu- 
al  tightnefs  in  the  cheft,  an  extreme  difficulty  of 
breathing,  with  pains  in  the  breaft,  flomach.  belly, 
and  fmall  of  the  back,  and  with  a  coldnefs  of  the 
extremities,  attended  with  great  reflleffnefs.  The 
fmall  of  the  back  was  fo  painful  that  it  was  oblig- 
ed to  be  held  by  a  fervant, 


.At 


APPENDIX.  313 

At  firft  her  attendants  were  not  much  alarmed, 
and  regarding  it  as  a  common  faintingfit,  gave  her 
wine  and  water,  and  fpirit  of  hartfhorn,  and  lav- 
ender drops  ;  but  finding  her  grow  rather  worfc 
than  better,  they  fent  to  a  neighbouring  town  for 
a  furgeon,  and  afterwards  for  a  phyfician,  two 
very  ingenious  men.  When  they  arrived  her  pulfe 
was  extremely  quick  and  languid,  but  regular  ; 
and  ihe  had  an  evident  finking  of  features.  Every 
thing  in  the  power  of  art  was  adminiftered  by 
them,  but  all  in  vain,  as  Ihe  might  be  faid  to  be  in 
articulo  mortis  when  they  arrived,  and  indeed  from 
her  firft  feizure.  She  expired  about  four  o'clock 
on  Saturday  morning,  continuing  fenfible  to 
the  laft. 

I  was  likewife  fent  for,  but  being  at  a  confidera- 
ble  diftance  did  not  reach  the  houfe,  being  flopped 
by  a  melfenger  within  a  few  miles  of  it,  to  inform 
me  of  the  melancholy  event.  I  never  faw  her  dur- 
ing her  confinement,  but  from  fome  particulars  of 
her  cafe,  which  I  received  from  the  furgeon,  who 
attended  her  during  her  laft  moments,  I  thought 
there  might  pofiibly  have  been  a  rupture  of  fome 
large  blood  veffel  in  the  thorax  ;  but  as  the  caufe 
of  her  death  was  by  no  means  clear,  and  the  cafe 
appeared  a  very  uncommon  one,  I  fent  over  to  re- 
queft  leave  to  open  the  body,  which  was  obtained. 

When 


314  APPENDIX. 

When  I  arrived  there  on  Monday  morning,  two 
days  after  her  death,  I  was  convinced,  on  the  firft 
appearance  of  the  body,  that  this  could  not  be  ow- 
ing to  any  blood  veflel  having  burfl  in  the  thorax, 
as  the  abdomen  was  diftended  almoft  as  much  as 
the  {kin  would  bear  without  buriling  ;  the  body  in 
the  moft  putrid  flate  I  ever  knew   one    at  that  fea- 
fon  of  the  year,  fo  foon  after  death  ;  and  a  general 
lividnefs  had  infufed  itfelf  from  the  lower  part  of 
the  belly,  to  the  whole  of  the  body. 


THE    DISSECTION 

Was  performed  in  the  prefence  of  the  phyfician 
and  furgeon  who  attended  the  lady.  As  foon  as  I 
cut  through  the  peritoneum,  a  large  quantity  of 
putrid  air  rufhed  out  of  the  abdomen,  which  confid- 
erably  leffened  its  Bulk ;  but  it  Itin  remained  very 
large,  owing  to  a  quantity  of  air  being  generated 
within  the  ftomarh  and  inteflines.  When  the 
whole  cavity  of  the  abdomen  was  laid  open,  we  oh- 
ferved,  on  examining  its  contents,  that  thofe  parts 
of  the  inteflines  which  lay  in  contact  with  the  ute- 
rus, were  in  a  gangrenous  (late,  and  of  a  very  livid 
colour.  The  uterus  was  of  the  fize  of  two  fifts, 
flabby,  loofe,  and  the  whole  in  a  Hate  of  gangrene. 
But  the  neck  and  the  right  fide  of  the  body  were 

in 


APPENDIX. 

in  the  tnoft  advanced   ftage,  all  its   coats  in  thofe 
places  being  completely  mortified. 

The  infide  of  the  uterus  was  covered  with  the 
lochia,  and  feemed  at  lead  not  in  a  worfe  ftate 
than  the  external  parts  of  it.  The  ovaria  Jimbrice, 
and  fallopian  tubes  were  in  the  lafl  ftage  of  a  fpha- 
celous,  being  perfectly  black,  and  exceedingly  pu- 
trid. There  was  nothing  remarkable  in  the  omen- 
turn,  bladder,  or  any  other  of  the  vifcera,  except  a 
general  lividity,  and  a  tendency  to  putrefaction. 

There  were  no  abfcej/es ;  the  inteftines  had  formed 
no  adhefions  ;  nor  were  there  any  inflammatory 
exudations,  extravafated  ferum,  or  flakes  of  coag- 
ulable  lymph,  as  defcribed  by  all  Englifh  writers 
on  the  puerperel  fever  ;  or  as  the  French  exprefs 
it,  any  of  that  extravafated  fluid  of  the  nature  of 
milk,  refembling  unclarified  whey,  containing 
flakes  of  curd  like  matter,  many  of  which  adhere 
to  the  furface  of  the  inteftines. 

Upon  opening  the  thorax,  there  was  no  putrid 
air,  nor  any  extravafated  blood  ;  the  pericardium 
contained  a  fufficient  quantity  of  water  ;  the  auri- 
cles and  ventricles  of  the  heart,  and  the  feptum  be- 
tween the  two  ventricles,  were  perfectly  found  ; 

#s  were  alfo  the  lungs, 

~ 

REMARKS. 


APPENDIX- 
REMARKS- 


There  are  feveral  circumftances  attending  this 
cafe,  that  feem  furprizing  and  require  fome  invefti- 
gation.  I  do  not  lay  much  ftrefs  upon  what  the 
lady  faid  to  the  midwife,  during  her  labour  ;  fuch 
expreffions  are  common,  and  no  more  is  thought 
of  them  if  the  patient  does  well.  Her  death  was 
evidently  occafioned  by  a  mortification  of  the  ute- 
rus, and  it  feems  extraordinary  that  me  made  no 
complaints  till  within  fix  hours  before  her  deceafe, 

Perhaps  it  may  be  faid  that  if  any  medical  per- 
fon  had  attended  her,  he  might  poffibly  have  dif- 
covered  fomething  either  in  her  pulfe  or  tongue,  or 
in  fome  other  fyrnptom,  from  which  to  have  prog- 
nofticated  her  danger  ;  but  I  think  this  is  not  prob- 
able, as  me  ate,  drank,  and  flept  well,  and  her  evac- 
uations and  difcharges  were  natural. 

^  May  we  not  account  for  the  fymptoms  in  the 
following  manner  ?  There  are  many  different  fpe- 
cies  of  mortifications  ;  fome  are  preceded  by  in- 
flammation and  irritation,  and  are  accompanied 
with  pain  and  fever*  from  the  firfl  attack  ;  others 

are 

*  '*  I  fnall  conclude  with  one  remark,  which,  thougk  it  has  been  made 
*{  before,  yet  has  not  been  fo  generally  received  as  to  render  any  farther  tef- 
f  *  timony  unnereQferv,  %be  :7?w  is,  for  th?,  -moft  part,  attended  with  a  fen- 

«  fible 


APPENDIX, 

are  not  ;  fome  are  dry,  fome  moid  ;  fome  are  of- 
fenfive  from  the  firft,  others  not  ;  fome  are  very 
quick  in  their  progrefs,  others  very  flow.  It  is 
evident  that  the  mortification  in  this  lady  was  not 
preceded  or  attended  with  any  inflammation  or  ir- 
ritation, fmce  flie  never  complained  of  any  pain 
till  within  fix  hours  of  her  death. 

The  uterus  is  an  organ  which  is  not  abfolutely 
neceffary  to  life,  fmce  many  animals  *  have  been 

known 

c<  fible  degree  of  fever,  and  with  all  the  other  fymptoms  recited  above; 

"  buc  befides  that,  there  are  cafes  in  which  there  is  no  vomiting,  as  Ihewa 

"  from  the  ancients  ;  there  are  others  in  which  the  fever  is  fcarcely  percep- 

"  tible,  when  the  patient  feels  little  pain,  and  is  not  altogether  coftive.     I 

"  fay,  there  are  fuch  cafes  of  inflammation  ;  becaufe  when  with  fymptoms  fb 

"  little  akrming,  the  patient  has  died,  the  bowels  have  been  found  not  lefs 
'*  mortified  than  after  the  moft  diftinguiihing  marks  of  the  difeafe. 

I 

"  This,  fo  far  as  I  know,  was  firft  taken  notice  of  by  Dr.  Simfon  ||,  whofe 

«  obfervation  is  quoted  and  confirmed  by  the  Baron  Van  Swieten  t,  and  late* 
"  ly  by  Morgagni  J,  who  obfcrves-  that  in  fuch  circumftances,  the  only  pre- 
"  fages  of  danger  are  to  be  taken  from  the  tenfion  of  the  belly,  and  a  dull 
*«  pain  upon  prefling  it,  from  the  lowlefs  and  inequality  of  the  pulfe,  and 
"  from  a  change  of  the  countenance.  What  he  fays  upon  this  fubjecl:  well 
«  dcfervcs  attention." 

Pringle's  Obfervations  on  Difeafes 
of  the  Army,  410.  p,  154* 


j|   Simfon  on  the  Syftem  of  the  Womb,  p.  106,  107. 
i  Comment,  on  Boerh.  Aphor.  §  371. 
$  De  Sed.  et  Couf.  Morb.  Ep.  35.  22. 


*  jfcdus  and  Paulus^Egineta,  fay,  that  they  have  known  even  women  re- 
cover, when  the  uterus  had  been  extirpated  on  accrtunt  of  an  inverfion,  and 
the  fariae  is  mentioned  by  Parc» 


3i8  APPENDIX. 

known  to  live  after  it  has  been  taken  out :  Hence 
the  fyftem  was  no  ways  afFe&ed  by  it,  till  the  mor- 
tification communicated  itfelf  to  the  inteflines, 
when  it  was  as  rapid  as  poflible,  denroying  the  pa- 
tient in  fix  hours. 

It  may  feem  remarkable  that  the  lochia  were  nev- 
er affe&ed  in  this  diforder  ;  but  let  us  confider 
whence  they  proceed.  The  lochia  are  nothing 
more  than  a  difcharge  of  blood  from  the  veflels 
which  formerly  opened  into  the  womb,  mixed  with 
the  putrid  remains  of  the  membrana  decidua,  cadu- 
ca,  or  fpongy  chorion,  and  as  there  might  be  nei- 
ther difcharge  nor  putrid  flench  from  the  parts 
actually  mortified,  the  lochia  were  not  affe&ed. 

The  uterus*  had  not  contracted  itfelf  fo  much 
as  might  have  been  expected  in  a  week  ;  it  is 
therefore  moft  probable  that  it  was  affefted  either  at 
the  time  or  foon  after  delivery  ;  nor  indeed  are  we 
able  to  trace  the  origin  of  this  difeafe  to  any  thing 

but 

*  Dr.  Hulme,  in  his  T>e?tife  on  the  Puerperal  Fever,  has  given  an  ac- 
count of  the  diffeftion  of  fix  women  who  died  of  that  difeafe,  and  has  men- 
tioned more  particularly  than  any  other  author,  the  degree  of  contraction  of 
the  uterus  in  them.  In  the-firft  five,  who  died  on  the  yth,  nth,  6th,  i8th, 
and  7th  days  after  delivery,  *'  the  uterus  was  contracted  to  a  fmall  compafs, 
"  and  lay  concealed  within  the  cavity  of  the  pelvis."  In  the  fixth  cafe,  in 
•which  the  patient  died  on  the  6th  day  after  delivery,  "  the  uterus  was  lefs 
«'  contracted,  and  lay  flabby  and  loofe  in  the  cavity  of  the  pelvis." 

De  Graaf  fays,  that  the  uterus  is  contracted  to  its  natural  Hze  in 
days  after  delivery,  Ch,  viii.  p.  128. 


APPENDIX. 


3*9 


but  her  labour,  which  was  a  fpeedy  one,  of  a  full 
grown  child. 

How  far  the  uterus  might  be  injured  by  the 
child,  in  its  paffage,  it  may  be  difficult  to  fay  ; 
but  thus  far  I  think  we  may  venture  to  conclude, 
that  in  all  fudden  labours,  we  mail  be  acting  on 
the  fafeft  fide,  if  we  do  every  thing  in  our  power 
to  retard,  and  nothing  to  accelerate  fuch  kind  of 
parturitions* 


INDEX, 


N         D         E         X. 


>/  i,  *»g* 

JjLBSORPTION'ot  the  Lochia,  occafioned  by  a  horizontal  pofturc     20,  27$ 

.  ,  the  caufe  of  the  Puerperal  Fever        .  -  30,  249,  268 

•  . .  occafioned  by  a  ftagnation,    not  obftru&ion  of  the 

lochia,  often  occurs  when  the  difcharge  is  great  -  .105 

•  and  obftruclion  of  the  Lochia,  their  diftinftion      -       270 


Advantages  of  fitting  up  foon  after  delivery  great         92,  102,  I53>  246,  274 
Airt  foul,  and   confined,    very  improper  for  lying  in  women     19,  81  f  90, 

102,  146 
.    -  •  worfe  among  poor  people  -  2 1 

pure  flaould  be  frequently  admitted  into  the  chamber      -      102,  16* 

——putrid,  how  ftudioufly  to  be  avoided,  -  -       124,  128,  151 

Aikin,  Dr.  his  Thoughts  on  Hofpitals  recommended  -       1 3$ 

. Dr.  his  Teftimony   of   the  fuccefs  of  the   Author's   Mode   of 

Praaice  -  -  -          286 

AfterpainS)  remarkable  proof  of  their  prevention  -          285 

mm  occafioned   by   premature  and   improper  delivery   of  the 

fhoulders  -  •         77»  85>  25*» 

Alexander,  Dr.  his  Experiments  and  Corollaries.  Note.  -  140 

Appearances  on  difleftion  of  women  who  have  died   of  the  Puerperal 

Fever  3°>  294>  3°7 

Applications,  greafy,  their  indifcriminate  ufe  condemned  ~  83 

4/cs?  Milk  fervkeable,  when  -  -.  60, 62 

Bark 


INDEX. 

V 

B. 

Page 

Bark  may  be  gitfen  daring  any  period  of  the  Puerperal  State          -        105 
..     when  ufeful  -  -  •         151,  160 

Bathing,  cold,  very  beneficial  in  preventing  mifcarriages,  and  to  nurfes 
giving  fuck  -  60,  253,  &  feq. 

- —  .  warm  and  vapour,  improper  in  the  Puerperal  Fever        -        158 

.    —  unfuccefsfully  ufed  in  the  Puerperal  Fever  -         277 

— temperate,  propofed  for  Puerperal  Women  in  lying  in  Hof- 

pitals  by  way  of  prevention,  when  the  fever  appears  in  a  malignant 
endemic  form  »  -  -  2?3 

.     i  .     ufed  in  ancient  and  modern  times,  before  and  after 
delivery  "  -  *    -  -  *  ibid* 

Bed,  a  plate  of  one  with  references  *  129,  &  feq. 

Bleeding^  its  ufe  too  prevalent  -  -  58, 62 

not  fuccefsful  in  the  Puerperal  Fever  -  245 

Bliflers,  very  improper  when  1581  &  feq.  167, 

ufeful  in  the  laft  ftage  of  the  Puerperal  Fever,  160 

<  their  ufe  in  the  Miliary  Fever  <  •  *7a 

Breajls,  their  (late  in  the  Puerperal  Fever  -  .26 

their  ftrufture  defcribed  •  53 

-'••  •«•»  require  great  attention  -  -  -        1 1  o,  &  feq» 

••  method  of  drawing  them  defcribed  -  Hi,  &feq. 

Broths,  their  impropriety  -  *  **«>• vj          94»  *°3 

Butter  Milk  much  drank  in  Manchefter  ••*'-$***  „  117 


C. 

Calculations  of  the  number  of  women  who  have  died  in  childbed  in 

London  and  other  towns  -  -  239,  &  feq, 

. ,  in  different  hofpitals  -  -  235 

Camphor,  its   ufe  improper  -  ..  167 

Chair,  a  very  convenient  one  defcribed  -  -  -  a  08 

a  Plate  of,  with  references  *  *  -  no 

Chamber,  lying  in,  directions  for  rendering  it  healthy         -  -         jox 

Chorion  or  Caduca,  Dr.  Hunter's  account  of  it  -          -        271,  &  feq« 

Chord,  umbilical,  when  to  be  divided  -  -  -85 

Ckghorn,  Dr.  his  account  of  the  appearances  on  diffeftion  of  perfons 

dead  of  Putrid  Fevers  -  *•  •  '  1         225 

Clyjlers  of  great  utility  in  preventing  Puerperal  Fevers  -        -        105- 

of  broth  improper  •  «  •          «•  ibid, 

when  proper  -  *  ,  .  14$ 


I     N    D     E    X. 


Columbo  root,  its  advantages                                  .                '  -            63 

—  --  Dr.  Percival's  experiments  upon.  Note  -        -        ibid. 

*—  ""•  •-  -  when  to  be  given                  -                •  "            J  49 

Cope,  Mr.  Extract  of  a  Letter  from                -                -  285,  &  feq. 
-  his  fuccefe  in  following  the  Author's  Mode  of  Treatment        -       284 

Conclufions  drawn  in  regard  to  the  Secundines                 -  -             218 

Cordials,  their  ufe  when  neceflary                                .  .               1?a 

Cojlivencfs  how  prejudicial             -                 *.                  •  153 

Crifis  of  the   Miliary  Fever  very  uncertain                 -  -             j^a 

Cul/cn,  Dr.  his    opinion  of  the  Miliary  Fever  49 

Cure  of  the  Miliary  Fever                 -                  -              -  161,  &  feq» 

-     «  i»  of  the  Puerperal  Fever            -               -              -  136,  &  feq. 


Davenport,  Mary,  her  Cafe                  -                -              -  213,  &  feq. 

DC  Haen,  Dr.  his  teftimony  on  the  Miliary  Fever  46 

Delivery,  j.cmperzte  bathing  ufed  before  and  after              -  -         278 

•  .....  —  of  the  moulders,  how  performed                 -  71 

Depofitions  of  matter  in  the  Puerperal  Fever             -             -  269,  &  feq. 

Diet  proper  for   Puerperal   Women            -     -                -  93 

Directions,  not  very  ferviceable  in  difcovering  the  caufe  of  the  Puerpe- 

ral Fever                               -             -              -          IPt!  -             a62 

Doulcct,  Mr.  his  opinion  of  the  Puerperal  Fever                 -  33 

••  •           his  Mode  of  treating  it                                .  142 

Draughts  of  Salt  of  Wormwood  when  proper  145 

.1                given  by  Reverius  and  Sydehham  when        '  '  «\  •*«  -          147 

up  their  aftion  d*efcribed  by  Lind  and    others  .               ibid. 

2)refrt  its  management  of  great  confequence                   -  53 

~-  —  what  proper  for  Pregnant  Women                   -  -                 66 

Jfyfentcrtes-almott.  unknown  in  Manchefter             -              .  •         118 

E. 

t 

£ggs,  raw,  their  good  effe£ls  in  the  jaundice                  -  -                 64. 

Llajlic  Vegetable  Bottles,   their   ufe.  Note                -             -  111,160 

Emetics,  when  advifeable  142,  &  feq. 

EmmenagogueS)  their  ufe  hurtful                 -                 >  160,  167 

Eruptions,  miliary,  known  to  attend  moil  difofders             •  -           39 

•••i   •          in  the  Puerperal  Fever  not  critical                 •  -               27 

Exercife,  when  improper  for  pregnant  Women              -  -            6at 

*•  .iwi  when  proper            «•     .                .      -               •  -60 

Fermenting 


I  • 

I     N    D     E    X.  323 

F. 

fermenting  antifeptic  mixtures  very  ufeful  when  -  ;  jg^ 

Tlaoding,  Gfiten  caufed?  by  too  hafty  delivery  83 

•  i  ••  its  proper  treatment  -  -  1  05  &  feq, 

fomentations  ,  warm,  improper  in  the  Puerperal  Fever  -  -  158 

fetus,  the  manner  in  which  its  moulders  pafs  through  the  Pelvis,  firft 

discovered  by  the  Author  -  7^. 

fumes,  dry  or  moift,  the  Author's  doubts  of  their  utility  during  the 

Patient's  ftay  in  the  room  -  -  131 

JFunis,  when  to  be  divided  -  -  -  .85 

G. 

"Getting  out  of  bed,  the  moft  effectual  method  of  promoting  the  Lochia       104 
Gunpowder,  explofions  of,  very  ferviceable  in  expelling  foul  Air        -      130 

H. 
Heat  of  the  body  mould  be  as  near  as  poflible   to  the  ftandard  of 

health  -  96,  139,  163 

——-may  be  fo  great  as  to  prevent  fweating  -  -  146 

Horizontal  Pojlure,  in  puerperal  Women  prevents  ftools  and  lochiafrom 

having  free  exit  -  -  »•  •  20 

>  -  •          •  '       •'  "  recommended  in  natural  labour  -  -  83 

"    •  .     i.      i  occafions  abforption  of  the  Lochia  -  27*,  476 

Horfeback,  fhort  rides  on,  ferviceable  in  preventing  mifcarriages        -      60 
Hofpitah,  Puerperal  Fever  not  eafily  prevented  in  -121 

-  defcription  of  a  Plan  of,  with  fome  improvements  -          123 

-  the  Author's  good  opinion  of,  in  general  -    •-         -          244 
—  '•           for  lying  in  Women,  their  different  fuccefs           -  *35i  &  ^e<3« 
Hotel  Dieu,  Mode  of  curing  the  Puerperal  Fever  in  it             »         -         1  42 
Hulme,  Dr.  his  Treatife  when  feen  by  the  Author  222,  &  feq. 
»   i.     -  remarks  upon  the  opinion  of  224,  &  feg, 
Hunter  t  Dr.  his  MS.  Leclures                                             •            »  249 

I. 

Infirmary  at  Manchefter,  a  defcription  of  •  -  124 

InjeElion  into  the  uterus  recommended  where  the  lochia  are  become  pu- 

trid ...  .  160 

Injlruments,  their  ufe  fometimes  needful  -  •  .  -  79 

Johnfon,  Dr,  his  Observations  on  the  Delivery  of  the  head  -  7» 

fyecacuanha,  ufed  with  great  fuccefs  in  the  Puerperal  Fever  at  the  Hotel 

Dieu  ,  .  ,.  ^  .  13 


D    E    X; 


Ipecacuanha,  Authors  claim  to  the  firft  ufe  of  it  .  •        »44 


its  good  effects  in  the  Miliary  Fever 


Jumps,  their  ufe  advifeable  during  pregnancy  ,  ~  66 

L. 

Labour,  the  moft  natural  cafe  of  fuppofed  -  86,  &  feq, 

Laceration  of  the  Perineum  frequent  in  confequence  of  hafty  delivery       83 
Liquors,  ftrong,  their  impropriety  .  "93 

•••*  •  '    "•  acid,   their  advantages  uo  the  Miliary  Fever  .  169 

Lochia,  ftagnating  in  the  womb,  become  acrid  and  abforbed  ..          21 

—  •  -  emollient  or  antifeptic  injections  into  the  uterus  very  beneficial 

in  removing  -  igo 

•  their  evacuation  alone  does  not  prevent  the  Puerperal  or  Mili- 
ary Fever  -  i 

Lochia  fometimes  much  leffened  and  fetid  z 

•  fhould  not  be  promoted  by  forcing  medicines        - 

•••    •        beft  promoted  by  getting  out  of  bed  -  -         ibid. 

—  —  —  larger  or  fmaller  difcharge  not   always  a  difeafe  -  105 
-'           their  abforption  occafioned  by  ftagnation,  not  obftruftion,  but 

often  occurs  when  the  difcharge  is  large  -  -  ibid. 

•  when  immoderate  the  proper  treatment  -          ibid* 

—  -  their  abforption  and  obftru&ion  not  properly  diftinguifhed         270 
Lord,  Mary,  her  Cafe  -  -  -  -         201,  &  feq, 

M- 

Management,  proper,   of  the   navel   firing,   firft.  difcovcred  by  the 

Author  I  ,*•  ':••:  -  ^  .  85,  &.  feq.  256 

Matter,  depofitions  of,  upon  the  internal  parts  fatal  -         269,  &.  feq. 

_—  __  -  upon  the  external  parts  a  fign  of  recovery          -        ibid. 
ffleaicines,  forcing,  when  improper  *         10^ 

Membrana  decidua,  what,  difcovered  by  Dr.  Hunter.   Note  -          87 

pi"  in  entirely  fitted  for  abforption  ••  272  &  feq, 

Menftruation  common  to   thofe  Quadrupeds  only  who  ufe  an  upright 

pofture  -  ...  277 

Metkod,  common,  of  tying  the  Funis  very  erroneous  -  85 

Miajtnata,  putrid,  contribute  greatly-to  the  fpreading  .of  the  diforder          21 
Midwifery,  the  art  of,  greatly  improved  of  late  -  70 

Miliary  fever,  doubtful  whether  known  to  the  Ancients        •        -  34 

"—•——*--  -  known  by  Riverius  -  -  -    :"  "        ~  3^ 

•    '  difcovered  in  England  bySydenham  in  1685  37 

»..!.  ..  •  L.,  Authors  various  in  thciy  opinions  about  the         <•  ibid* 

,  &L 


INDEX.  325 

Page 

MiKary  Fever,  fully  defcribed  by  Allomus  40 

•— — — — —  its  fymptoms                                 -  •                  ibid* 

— — once  very  fatal  in  Manchefter               -  -                 43 

.     ..-.- —  once  fuppofed  to  be  endemic  at  Chefter  45 

—  Eruptions  never  come  out  without  a  fweat  -               44,  16* 

......   i             are  fabricated,  not  critical               -  46 


ii              Fever y  Dr.  Cullen's  account  of  49 

.     ....   .  ..  ..  its  cure            -                                 -                 161,  &  feq» 

t- ,                 its  laft  ftage  hazardous            ...  1 73 

Milk  Fever,  its  caufes                                          -  51 

_ — . why  more  common  to  Women  of  rank           -  55 

Affes,  ferviceable  when  -  •  60, 6a 

Mortification  of  the  Womb                                 -                    -  314 

Uufky  when  ufeful                -                    -                -  172 

N. 

Nature  to  be  obferved  in  her  operations                 »                -  76 

when  to  be  affifted  in  her  operations                               -  85 

Navel  String,  bad  confequences  attending  the  tying  and  cutting  it  im- 
mediately after  birth                                                             86,  256  &  feq/ 
•  ••                 the  proper  management  firft  difcovered  and  recommend- 
ed by  the  Author                -                                                        256,  &  feq. 
Nitre,  proper  in  floodings                 -  108 
"     '  '  improper  in  the  Puerperal  Fever                 -                -  15$ 

— in  the  Miliary  Fever              -             -                 -  ^67 

Northampton.  Puerperal  Fever  very  fatal  there                           -               12O,  234 

Number  of  attendants  hurtful  to  Women  in  Labour                    -  19 

Nurfes  have  great  (hare  in  the  management  of  Lying  in  Women  33 

• —  too  much  left  to  their  management  in  London             -  119 

O. 

Qbjlruttion  and  absorption  of  the  Lochia,  their  difference            -  270 
Omentum  and  inteftines,  their  inflammation  and  mortification  not  the 

true  caufe  of  the  Puerperal  Fever                  -                    -  229 

Opiates,  when  neceffary                •  82 

y •  when  improper                    ,.                    -                -  169 

P. 

Parturition,  natural,  what  method  to  be  obferved  in                -  80 

Pains,  falfe,  or  fpurious,  their  difference                                  -  231 

Perfpiration  and  fweat,  the  difference  not  generally  known        -  97 

hie  observations  on  the  effefts  of  Putrid  Effluvia,  Note          •  a  at 
•                                                                                  Perfumes 

- 


326  INDEX. 

Perfumes  of  b*d  confequence                               -  .                    ^ 

fhlebfitomy,  when  improper                            .                 .  156,  &  feq. 

^d^enta9  how  to  ke  extra&«*                     •                     -  87,  &  feq. 

---  fatal  caufes  of                 -                  -  214,  &  feq. 

----  irs  retention,  an  objeft  of  controverfy            .  6g 

i\'j'i  .•"«,  ks  confequence  when  „              j  t^ 

-  --  during  delivery                    ~                    "  "                      83 
.  —   ...  horizontal,  the  caufe  of  the  Lochia  being  abforbcd      -       270   276? 
Pofture,  fudden  alteration  of  it  dangerous  _                 jgg 
-.L          upright  of  the  greateft  confequence  after  delivery  $$y  &  fCn.  i  *% 

2*6,  274 

Puerperal  Fever,  its  fymptoms  -  -  17,  &  feq. 

.     .....  -  -well  known  to  Hippocrates  -  »  27 

-  .....  -    i  not  to  be  afcribed  to  Inflammation  alone  -  gj 
"               --  frequently  malignant                  -                   -                   ibid, 

-  ---  aggravated  by  heat  of  Air  32 
»  '          -  ..  —  .-.  '  more  fatal  in  Hofpitals  than  in  private  practice      22,  &  feq. 
-—  —  —  --  occafioned  by  abforption                   -                  31,102,105 
,  --  1  .    .,-,  .,.,  .  never  produced  without  foul  Air,  accumulation  of  fe- 

ces,  or  horizontal  pofture  ...  joa 

»  ---  -  the  Author  never  loft  a  Patient  whom  he  had  deliver- 


ed in  it                    -                  -                      -                 -  115 

--  more  common  and  fatal  in  London  than  in  the  country  1  1  9 

-.  -  fatal  by  wrong  treatment                 -  121 

_  -  -  .  may  aiways  be  prevented  except  in  Hofpitals       -  ibid. 


if  managed  according  to  the  Author's  directions  gener- 
ally curable  «•  154 
why  fo  common  and  fatal  at  Northampton         -             233 


.  not  fo  general  as  from  the  afligned  caufes  it  might  be       37 

—  obferved  by  iome  to  be  very  fatal  in  1770,  but  not  in- 
variably fo  •  235 

^. the  difcovery  of  its  caufes  not  much  afiifted  by  dif- 

feaions  262 

_u      -  -  - .  tranflation  of  the  difeafe  to  the  external  parts  a  fign  of 


recovery  •  266,  &  feq. 

— ItftffeM  adtrifed  to  ufe  the  temperate  Bath  when  in  hofpitals      278 

P*lfc9  its  quicknefs  a  moft  diftinguiming  fymptotai  in  the  Puerperal  Fe- 
ver 263,  &  feq. 
•«—••-  quick  in  all  abforptioafi  of  matter                *                -  ^64 


INDEX.  327 

' 

R, 

Page 

Ravtnfcroft,  £llent  her  Cafe                                   .  1 86 

Regijlers  of  different  difeafes,  how  long  kept  in  Manchefter  •          239 

Repofe  upon  a  couch  when  advifeable  67 

Rigg,  Betty,  her  Cafe  and  Direction  174,  &  feq. 

- —  Remarks  upon  the  Cafe  of  J75>  &  feq^ 

Rings  of  Bees'  Wax,  their  ufe  -                 113 

S. 

Sago,  its  fenfible  qualities  -  g^ 

Secundines,  their  retention  an  object  of  controverfy  ga 

Shoulders,   of  the  Child,  the  manner  in   which  they  naturally  pafs 
through  the  Pelvis  firft  difcovered  by  the  Author        -  .  ^ 

.- >  common  directions  for  delivering  them  improper        -  75 

•• their  improper  delivery  productive  of  great  inconveniences 

75>  254.  85 
Sitting  up  in  Bed  foon  after  delivery  of  the  utmoft  confequence      92,    &  feq. 

J52»  246,  274 

Spungy  Chorion  entirely  fitted  for  abforption  272  &  feq. 

Stagnation  of  the  Lochia  the  caufe  of  their  abforption          -  104. 

Stays,  tight,  their  bad  confequence  •  -  66 

Sweat  and  perfpiration  not  diftinguiflied  by  the  ignorant  .  97 

Sweating  in  Bed,  hurtful  to  a  perfon  in  health  -  -  go 

••.   •    I..  -  particularly  hurtful  to  Puerperal  Women,  and  in  all  low  nerv- 
ous nnrl  PiitrM  Fevprs  -  -  -  JOO 

. .  to  what  extremes  carried  -  1 Q* 

Sweat  will  terminate  a  paroxifm  of  an  Ague,  but  not  prevent  a  frefli 
acceflion  -  .  JO|, 

. critical,  an  act  of  Nature,  and  beft  promoted  by  what        -        ibid. 

—— when  improper  -  -  -  141 
perfons  may  be  too  hot  for  that  evacuation  .  .  ^(J 

T. 

Temperature  of  the  Lying  in  Chamber,  its  confequence  ^  '  -  96 
Tcnefmus,  frequent  in  the  acceflion  of  the  Puerperal  Fever  -  25 
Tightnefs  of  the  Stays,  hurtful  to  Pregnant  Women  -  -  18 
Treatment ,  what  proper  for  preventing  Puerperal  diforders  -  90,  &  feq. 
of  Floodings  .  jo5j  &  feq% 

U, 

Upright  Pofture,  of  th«  utmoft  coafequence  after  delivery   92,  &  feq,  1 52,  246 

Urine 
*f 


IN    D    E    X. 

Urine  voided  often,  and  very  turbid  -  2s 

Uterus,  gravid  prefling  upon  the  omentum  and  inteftines,  fuppofed  to 
p  be  the  true  caufe  of  the  Puerperal  Fever  by  Dr.  Hulme  229,  &  feq. 

• controverted  by  the  Author  -  -  231,  &  feq. 

~ mortification  of  .  Vt. , »  -  31  ^ 

V. 

Vegetables^  their  ufe  mucfc  recommended  -  95 

Ventilators t  their  ufe  -  -  .-  128 

Vinepar  fumigating  Wards  with,  not  fo  antifeptic  as  was  fuppofed  131 

Volatile*,  improper  when  -  -  107,168 

Vomits i  gentle,  ftrviceable  63,  144,  &  feq  170,  &  feq. 

W. 

Warm  Bathings ,  unfuccefsful  in  the  Puerperal  Fever  -  «         277 

7F 'atert  pump,  much  ufed  in  Manchefter  -  -  118 

Obfervations  on  that  of  London,  by  Dr.  Heberden.  Note         -     ibid. 

Whitehead,  Dr,  his  tranflation  of  Doulcet's  Memoir  -  33,  143 

Winet  its  ufe,  when  neceflary  -  -  -  170 

Women,  puerperal,  fubjeft  to  putrefccnt  diforders  -  17 

•"          — • too  much  confined  to  a  horizontal  pofture  after  delivery    20 

•  —  '  mould  get  out  of  bed  the  day  of  delivery      -       icz,  275 

~- fhould  fit  up  in  bed  in  an  hour  or  two  after  delivery     274 

delivered  by  the  Author,  never  troubled  with  Prolapfus  Vaginae     246 

Wri£ley,  Mary,  her  Cafe  .  .  .  205,  &  feq. 

X  • 

Young t  Dr.  recommends  the  cool  regimen  -  .  234 

,     his  defcription  of  the  Lying  in  Ward  at  Edinburgh         -  251 

*  '  •""•'  bis  account  of  the  Puerperal  Fever,  as  it  appeared  ia  that  place     281 


IJ 


